17D2159129 CLIA NUMBER - WALMART PHARMACY 10-1187

Laboratory Demographics

  • CLIA Code: 17D2159129
  • Facility Name: WALMART PHARMACY 10-1187
  • Facility Address: 2200 N STATE ST
    IOLA, KS
    ZIP 66749
  • Facility Phone: 620 365-7637
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REBECCA STEPHENSON
  • NPI Number: 1194742593
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159129
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1187
Street 2200 N STATE ST
City IOLA
State KS
ZIP 66749
Phone 620 365-7637
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 REBECCA STEPHENSON

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This page was last updated on: 3/20/2025