17D2159377 CLIA NUMBER - WALMART PHARMACY 10-1221

Laboratory Demographics

  • CLIA Code: 17D2159377
  • Facility Name: WALMART PHARMACY 10-1221
  • Facility Address: 6110 W KELLOGG DR
    WICHITA, KS
    ZIP 67209
  • Facility Phone: 316 945-8181
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW ABUKALAM
  • NPI Number: 1487194965
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2159377
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1221
Street 6110 W KELLOGG DR
City WICHITA
State KS
ZIP 67209
Phone 316 945-8181
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2024
Certificate Expiration Date 12/17/2026
Facility Type Pharmacy
Lab Director ANDREW ABUKALAM

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