14D2140369 CLIA NUMBER - WALMART PHARMACY 10-4049

Laboratory Demographics

  • CLIA Code: 14D2140369
  • Facility Name: WALMART PHARMACY 10-4049
  • Facility Address: 21000 WESTERN AVE
    OLYMPIA FIELDS, IL
    ZIP 60461
  • Facility Phone: 708 898-9114
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IRWIN OBISPO
  • NPI Number: 1205289246
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2140369
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4049
Street 21000 WESTERN AVE
City OLYMPIA FIELDS
State IL
ZIP 60461
Phone 708 898-9114
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 IRWIN OBISPO

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