15D2129522 CLIA NUMBER - WALMART PHARMACY #10-0870

Laboratory Demographics

  • CLIA Code: 15D2129522
  • Facility Name: WALMART PHARMACY #10-0870
  • Facility Address: 4040 N NEWTON ST
    JASPER, IN
    ZIP 47546
  • Facility Phone: 812 634-1777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY STENFTENAGEL
  • NPI Number: 1679590897
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2129522
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-0870
Street 4040 N NEWTON ST
City JASPER
State IN
ZIP 47546
Phone 812 634-1777
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 AMY STENFTENAGEL

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