17D2123283 CLIA NUMBER - WALMART PHARMACY 10-592

Laboratory Demographics

  • CLIA Code: 17D2123283
  • Facility Name: WALMART PHARMACY 10-592
  • Facility Address: 2020 N NELSON DR
    DERBY, KS
    ZIP 67037
  • Facility Phone: 316 788-3731
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSAN J. HILLEY
  • NPI Number: 1275550667
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2123283
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-592
Street 2020 N NELSON DR
City DERBY
State KS
ZIP 67037
Phone 316 788-3731
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Pharmacy
Lab Director SUSAN J. HILLEY

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