14D2140363 CLIA NUMBER - WALMART PHARMACY 10-03602

Laboratory Demographics

  • CLIA Code: 14D2140363
  • Facility Name: WALMART PHARMACY 10-03602
  • Facility Address: 1100 LEJUNE DR
    SPRINGFIELD, IL
    ZIP 62703
  • Facility Phone: 217 529-6299
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBBIE J. WOLKE
  • NPI Number: 1508028333
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2140363
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-03602
Street 1100 LEJUNE DR
City SPRINGFIELD
State IL
ZIP 62703
Phone 217 529-6299
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Pharmacy
Lab Director ROBBIE J. WOLKE

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This page was last updated on: 9/29/2025