15D2144691 CLIA NUMBER - WALMART PHARMACY #10-1327

Laboratory Demographics

  • CLIA Code: 15D2144691
  • Facility Name: WALMART PHARMACY #10-1327
  • Facility Address: 567 IVY TECH DR
    MADISON, IN
    ZIP 47250
  • Facility Phone: 812 273-4993
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW RAFLA
  • NPI Number: 1376626002
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2144691
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1327
Street 567 IVY TECH DR
City MADISON
State IN
ZIP 47250
Phone 812 273-4993
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 ANDREW RAFLA

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