15D2144675 CLIA NUMBER - WALMART PHARMACY #10-1275

Laboratory Demographics

  • CLIA Code: 15D2144675
  • Facility Name: WALMART PHARMACY #10-1275
  • Facility Address: 2440 N LEBANON ST
    LEBANON, IN
    ZIP 46052
  • Facility Phone: 765 782-6070
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRUCE R. HUCKSTEP
  • NPI Number: 1760409072
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2144675
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1275
Street 2440 N LEBANON ST
City LEBANON
State IN
ZIP 46052
Phone 765 782-6070
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 BRUCE R. HUCKSTEP

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