15D2161036 CLIA NUMBER - WALMART PHARMACY #10-3436

Laboratory Demographics

  • CLIA Code: 15D2161036
  • Facility Name: WALMART PHARMACY #10-3436
  • Facility Address: 700 W IRELAND RD
    SOUTH BEND, IN
    ZIP 46614
  • Facility Phone: 574 299-1464
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSICA VERA
  • NPI Number: 1598822850
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2161036
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-3436
Street 700 W IRELAND RD
City SOUTH BEND
State IN
ZIP 46614
Phone 574 299-1464
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2025
Certificate Expiration Date 1/23/2027
Facility Type Pharmacy
Lab Director JESSICA VERA

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