15D2161039 CLIA NUMBER - WALMART PHARMACY #10-4399

Laboratory Demographics

  • CLIA Code: 15D2161039
  • Facility Name: WALMART PHARMACY #10-4399
  • Facility Address: 30830 OLD US 20
    ELKHART, IN
    ZIP 46514
  • Facility Phone: (574) 674-5730
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENDAN UGWOKE
  • NPI Number: 1013934231
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2161039
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4399
Street 30830 OLD US 20
City ELKHART
State IN
ZIP 46514
Phone 5746745730
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 BRENDAN UGWOKE

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This page was last updated on: 5/18/2026