15D2144669 CLIA NUMBER - WALMART PHARMACY #10-0922

Laboratory Demographics

  • CLIA Code: 15D2144669
  • Facility Name: WALMART PHARMACY #10-0922
  • Facility Address: 2363 HIGHWAY 135 NW
    CORYDON, IN
    ZIP 47112
  • Facility Phone: 812 738-4551
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA R. ETTNER
  • NPI Number: 1417039660
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2144669
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-0922
Street 2363 HIGHWAY 135 NW
City CORYDON
State IN
ZIP 47112
Phone 812 738-4551
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 AMANDA R. ETTNER

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