16D2143349 CLIA NUMBER - WALMART PHARMACY 10-0750

Laboratory Demographics

  • CLIA Code: 16D2143349
  • Facility Name: WALMART PHARMACY 10-0750
  • Facility Address: 302 ENTERPRISE DR
    INDEPENDENCE, IA
    ZIP 50644
  • Facility Phone: 479 277-2374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONNIE R. DIVIS
  • NPI Number: 1003833476
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2143349
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0750
Street 302 ENTERPRISE DR
City INDEPENDENCE
State IA
ZIP 50644
Phone 479 277-2374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2024
Certificate Expiration Date 1/28/2026
Facility Type Pharmacy
Lab Director CONNIE R. DIVIS

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