14D2140419 CLIA NUMBER - WALMART PHARMACY #775

Laboratory Demographics

  • CLIA Code: 14D2140419
  • Facility Name: WALMART PHARMACY #775
  • Facility Address: 659 KNOX SQUARE DR
    GALESBURG, IL
    ZIP 61401
  • Facility Phone: 309 344-2254
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTY N. MIELCAREK
  • NPI Number: 1548466717
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2140419
LAB Type Pharmacy
Facility Name WALMART PHARMACY #775
Street 659 KNOX SQUARE DR
City GALESBURG
State IL
ZIP 61401
Phone 309 344-2254
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 KRISTY N. MIELCAREK

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