14D2140404 CLIA NUMBER - WALMART PHARMACY 10-5399

Laboratory Demographics

  • CLIA Code: 14D2140404
  • Facility Name: WALMART PHARMACY 10-5399
  • Facility Address: 1640 S GALENA AVE
    DIXON, IL
    ZIP 61021
  • Facility Phone: 815 288-7797
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AARON T. OVERSTREET
  • NPI Number: 1366452518
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2140404
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5399
Street 1640 S GALENA AVE
City DIXON
State IL
ZIP 61021
Phone 815 288-7797
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 AARON T. OVERSTREET

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