15D2146287 CLIA NUMBER - WALMART PHARMACY #10-1142

Laboratory Demographics

  • CLIA Code: 15D2146287
  • Facility Name: WALMART PHARMACY #10-1142
  • Facility Address: 1618 W MCCLAIN AVE
    SCOTTSBURG, IN
    ZIP 47170
  • Facility Phone: 812 752-7122
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW JERRELL
  • NPI Number: 1740363464
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2146287
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1142
Street 1618 W MCCLAIN AVE
City SCOTTSBURG
State IN
ZIP 47170
Phone 812 752-7122
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 MATTHEW JERRELL

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