17D2159036 CLIA NUMBER - WALMART PHARMACY 10-5307

Laboratory Demographics

  • CLIA Code: 17D2159036
  • Facility Name: WALMART PHARMACY 10-5307
  • Facility Address: 1725 E SANTA FE ST
    GARDNER, KS
    ZIP 66030
  • Facility Phone: 913 884-8411
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY BOKELMAN
  • NPI Number: 1326132481
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159036
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5307
Street 1725 E SANTA FE ST
City GARDNER
State KS
ZIP 66030
Phone 913 884-8411
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Pharmacy
Lab Director AMY BOKELMAN

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