15D2146293 CLIA NUMBER - WALMART PHARMACY #10-1618

Laboratory Demographics

  • CLIA Code: 15D2146293
  • Facility Name: WALMART PHARMACY #10-1618
  • Facility Address: 2936 E 79TH AVE
    MERRILLVILLE, IN
    ZIP 46410
  • Facility Phone: 219 947-1309
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE BOEHNE
  • NPI Number: 1366524274
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 15D2146293
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1618
Street 2936 E 79TH AVE
City MERRILLVILLE
State IN
ZIP 46410
Phone 219 947-1309
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 STEPHANIE BOEHNE

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