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16D2126066 CLIA NUMBER - WALMART PHARMACY 10-2004

Laboratory Demographics

CLIA Number: 16D2126066

Facility Name: WALMART PHARMACY 10-2004

Facility Address:
4200 DODGE STREET
DUBUQUE, IA
ZIP 52003
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Facility Phone Number: 563 582-1519

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1568489953

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 16D2126066
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2004
Street 4200 DODGE STREET
City DUBUQUE
State IA
ZIP 52003
Phone 563 582-1519
CertificateType 4
CertificateEffectiveDate 2/20/2023
CertificateExpirationDate 2/19/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024