17D2159147 CLIA NUMBER - WALMART PHARMACY 10-2855

Laboratory Demographics

  • CLIA Code: 17D2159147
  • Facility Name: WALMART PHARMACY 10-2855
  • Facility Address: 16100 W 65TH ST
    SHAWNEE, KS
    ZIP 66217
  • Facility Phone: 913 268-3545
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JONATHAN B. BROCKER
  • NPI Number: 1568489987
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159147
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2855
Street 16100 W 65TH ST
City SHAWNEE
State KS
ZIP 66217
Phone 913 268-3545
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 JONATHAN B. BROCKER

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