15D2144683 CLIA NUMBER - WALMART PHARMACY #10-0566

Laboratory Demographics

  • CLIA Code: 15D2144683
  • Facility Name: WALMART PHARMACY #10-0566
  • Facility Address: 1115 AMERICAN WAY
    BOONVILLE, IN
    ZIP 47601
  • Facility Phone: 812 897-5964
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON S. BROEKER
  • NPI Number: 1831272558
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2144683
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-0566
Street 1115 AMERICAN WAY
City BOONVILLE
State IN
ZIP 47601
Phone 812 897-5964
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 JASON S. BROEKER

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