16D2128856 CLIA NUMBER - WALMART PHARMACY 10-1415

Laboratory Demographics

  • CLIA Code: 16D2128856
  • Facility Name: WALMART PHARMACY 10-1415
  • Facility Address: 2200 17TH ST
    SPIRIT LAKE, IA
    ZIP 51360
  • Facility Phone: 712 336-1756
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BROOKE WITTROCK
  • NPI Number: 1487671988
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2128856
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1415
Street 2200 17TH ST
City SPIRIT LAKE
State IA
ZIP 51360
Phone 712 336-1756
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2025
Certificate Expiration Date 4/9/2027
Facility Type Pharmacy
Lab Director BROOKE WITTROCK

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