15D2146286 CLIA NUMBER - WALMART PHARMACY #10-2276

Laboratory Demographics

  • CLIA Code: 15D2146286
  • Facility Name: WALMART PHARMACY #10-2276
  • Facility Address: 333 BOYD BLVD
    LA PORTE, IN
    ZIP 46350
  • Facility Phone: 219 325-3130
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAIWO AWOSILCE
  • NPI Number: 1679591531
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2146286
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2276
Street 333 BOYD BLVD
City LA PORTE
State IN
ZIP 46350
Phone 219 325-3130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2024
Certificate Expiration Date 3/26/2026
Facility Type Pharmacy
Lab Director TAIWO AWOSILCE

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