17D2159131 CLIA NUMBER - WALMART PHARMACY #42

Laboratory Demographics

  • CLIA Code: 17D2159131
  • Facility Name: WALMART PHARMACY #42
  • Facility Address: 1863 CR 5300
    COFFEYVILLE, KS
    ZIP 67337
  • Facility Phone: 620 251-4145
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATELYN B. SHEPARD
  • NPI Number: 1366469751
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159131
LAB Type Pharmacy
Facility Name WALMART PHARMACY #42
Street 1863 CR 5300
City COFFEYVILLE
State KS
ZIP 67337
Phone 620 251-4145
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 KATELYN B. SHEPARD

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