15D2129515 CLIA NUMBER - WALMART PHARMACY #10-0617

Laboratory Demographics

  • CLIA Code: 15D2129515
  • Facility Name: WALMART PHARMACY #10-0617
  • Facility Address: 757 W WOLFE ST
    SULLIVAN, IN
    ZIP 47882
  • Facility Phone: 812 268-4626
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER R. DECOURSEY
  • NPI Number: 1750309605
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2129515
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-0617
Street 757 W WOLFE ST
City SULLIVAN
State IN
ZIP 47882
Phone 812 268-4626
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director JENNIFER R. DECOURSEY

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