17D2159110 CLIA NUMBER - WALMART PHARMACY 10-1151

Laboratory Demographics

  • CLIA Code: 17D2159110
  • Facility Name: WALMART PHARMACY 10-1151
  • Facility Address: 10824 PARALLEL PKWY
    KANSAS CITY, KS
    ZIP 66109
  • Facility Phone: 913 788-3202
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRYAN M. DESTRY
  • NPI Number: 1568489961
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159110
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1151
Street 10824 PARALLEL PKWY
City KANSAS CITY
State KS
ZIP 66109
Phone 913 788-3202
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Pharmacy
Lab Director BRYAN M. DESTRY

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