15D2161540 CLIA NUMBER - WALMART PHARMACY #10-4231

Laboratory Demographics

  • CLIA Code: 15D2161540
  • Facility Name: WALMART PHARMACY #10-4231
  • Facility Address: 7502 SOUTHTOWN CROSSING BLVD
    FORT WAYNE, IN
    ZIP 46816
  • Facility Phone: 260 441-7083
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY J. GUIDO
  • NPI Number: 1942211461
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2161540
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4231
Street 7502 SOUTHTOWN CROSSING BLVD
City FORT WAYNE
State IN
ZIP 46816
Phone 260 441-7083
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/5/2025
Certificate Expiration Date 2/4/2027
Facility Type Pharmacy
Lab Director ANTHONY J. GUIDO

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