14D2140380 CLIA NUMBER - WALMART 10-3790

Laboratory Demographics

  • CLIA Code: 14D2140380
  • Facility Name: WALMART 10-3790
  • Facility Address: 16241 S FARRELL RD
    LOCKPORT, IL
    ZIP 60441
  • Facility Phone: 815 836-3422
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TOMAS I. GARBALIAUSKAS
  • NPI Number: 1922292432
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2140380
LAB Type Pharmacy
Facility Name WALMART 10-3790
Street 16241 S FARRELL RD
City LOCKPORT
State IL
ZIP 60441
Phone 815 836-3422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Pharmacy
Lab Director TOMAS I. GARBALIAUSKAS

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