15D2133205 CLIA NUMBER - WALMART PHARMACY #10-4235

Laboratory Demographics

  • CLIA Code: 15D2133205
  • Facility Name: WALMART PHARMACY #10-4235
  • Facility Address: 2399 S STATE ROAD 46
    TERRE HAUTE, IN
    ZIP 47803
  • Facility Phone: 812 872-2533
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RUSH SOMMERVILLE
  • NPI Number: 1841308236
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2133205
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4235
Street 2399 S STATE ROAD 46
City TERRE HAUTE
State IN
ZIP 47803
Phone 812 872-2533
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Pharmacy
Lab Director RUSH SOMMERVILLE

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