17D2123284 CLIA NUMBER - WALMART 10-664

Laboratory Demographics

  • CLIA Code: 17D2123284
  • Facility Name: WALMART 10-664
  • Facility Address: 4301 VINE ST
    HAYS, KS
    ZIP 67601
  • Facility Phone: 479 258-6036
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DARIN L. ROHR
  • NPI Number: 1104907179
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 17D2123284
LAB Type Pharmacy
Facility Name WALMART 10-664
Street 4301 VINE ST
City HAYS
State KS
ZIP 67601
Phone 479 258-6036
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 DARIN L. ROHR

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This page was last updated on: 6/4/2025