16D2130661 CLIA NUMBER - WALMART PHARMACY 10-2714

Laboratory Demographics

  • CLIA Code: 16D2130661
  • Facility Name: WALMART PHARMACY 10-2714
  • Facility Address: 500 11TH ST SW
    SPENCER, IA
    ZIP 51301
  • Facility Phone: (712) 262-5011
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON T. ELLIS
  • NPI Number: 1912924309
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2130661
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2714
Street 500 11TH ST SW
City SPENCER
State IA
ZIP 51301
Phone 7122625011
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Pharmacy
Lab Director JASON T. ELLIS

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