17D2159142 CLIA NUMBER - WALMART PHARMACY 10-486

Laboratory Demographics

  • CLIA Code: 17D2159142
  • Facility Name: WALMART PHARMACY 10-486
  • Facility Address: 12801 KANSAS AVE
    BONNER SPRINGS, KS
    ZIP 66012
  • Facility Phone: 913 441-8800
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COREY A. DUNN
  • NPI Number: 1184641573
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159142
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-486
Street 12801 KANSAS AVE
City BONNER SPRINGS
State KS
ZIP 66012
Phone 913 441-8800
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 COREY A. DUNN

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