14D2140400 CLIA NUMBER - WALMART PHARMACY #0612

Laboratory Demographics

  • CLIA Code: 14D2140400
  • Facility Name: WALMART PHARMACY #0612
  • Facility Address: 2250 LINCOLN AVE
    CHARLESTON, IL
    ZIP 61920
  • Facility Phone: 217 345-9458
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NANCY MARTIN
  • NPI Number: 1477636090
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2140400
LAB Type Pharmacy
Facility Name WALMART PHARMACY #0612
Street 2250 LINCOLN AVE
City CHARLESTON
State IL
ZIP 61920
Phone 217 345-9458
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 NANCY MARTIN

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