15D2144667 CLIA NUMBER - WALMART PHARMACY #10-1304

Laboratory Demographics

  • CLIA Code: 15D2144667
  • Facility Name: WALMART PHARMACY #10-1304
  • Facility Address: 2501 WALTON BLVD
    WARSAW, IN
    ZIP 46582
  • Facility Phone: 574 269-7811
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE N. GOSS
  • NPI Number: 1528140449
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2144667
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1304
Street 2501 WALTON BLVD
City WARSAW
State IN
ZIP 46582
Phone 574 269-7811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Pharmacy
Lab Director STEPHANIE N. GOSS

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