16D2130657 CLIA NUMBER - WALMART PHARMACY 10-5115

Laboratory Demographics

  • CLIA Code: 16D2130657
  • Facility Name: WALMART PHARMACY 10-5115
  • Facility Address: 3101 W KIMBERLY RD
    DAVENPORT, IA
    ZIP 52806
  • Facility Phone: 563 445-1098
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DOMINIC TANGANG
  • NPI Number: 1285651679
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2130657
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5115
Street 3101 W KIMBERLY RD
City DAVENPORT
State IA
ZIP 52806
Phone 563 445-1098
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2023
Certificate Expiration Date 5/14/2025
Facility Type Pharmacy
Lab Director DOMINIC TANGANG

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This page was last updated on: 3/20/2025