15D2144682 CLIA NUMBER - WALMART PHARMACY #10-1378

Laboratory Demographics

  • CLIA Code: 15D2144682
  • Facility Name: WALMART PHARMACY #10-1378
  • Facility Address: 2304 LINCOLNWAY E
    GOSHEN, IN
    ZIP 46526
  • Facility Phone: 574 534-4094
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BETH LONGBRAKE
  • NPI Number: 1407938624
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2144682
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1378
Street 2304 LINCOLNWAY E
City GOSHEN
State IN
ZIP 46526
Phone 574 534-4094
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 BETH LONGBRAKE

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