15D2146294 CLIA NUMBER - WALMART PHARMACY #10-4230

Laboratory Demographics

  • CLIA Code: 15D2146294
  • Facility Name: WALMART PHARMACY #10-4230
  • Facility Address: 10105 LIMA RD
    FORT WAYNE, IN
    ZIP 46818
  • Facility Phone: 260 490-6510
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDI JOHNSON
  • NPI Number: 1801072251
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2146294
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4230
Street 10105 LIMA RD
City FORT WAYNE
State IN
ZIP 46818
Phone 260 490-6510
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 BRANDI JOHNSON

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