17D2159122 CLIA NUMBER - WALMART 10-111

Laboratory Demographics

  • CLIA Code: 17D2159122
  • Facility Name: WALMART 10-111
  • Facility Address: 2700 S SANTA FE AVE
    CHANUTE, KS
    ZIP 66720
  • Facility Phone: 620 431-4064
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENEL R. EISENBART
  • NPI Number: 1629154877
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 17D2159122
LAB Type Pharmacy
Facility Name WALMART 10-111
Street 2700 S SANTA FE AVE
City CHANUTE
State KS
ZIP 66720
Phone 620 431-4064
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 JENEL R. EISENBART

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