17D2164800 CLIA NUMBER - WALMART PHARMACY 10-770

Laboratory Demographics

  • CLIA Code: 17D2164800
  • Facility Name: WALMART PHARMACY 10-770
  • Facility Address: 3503 10TH ST
    GREAT BEND, KS
    ZIP 67530
  • Facility Phone: 620 792-5237
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER V. NEMICH
  • NPI Number: 1720005127
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2164800
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-770
Street 3503 10TH ST
City GREAT BEND
State KS
ZIP 67530
Phone 620 792-5237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Pharmacy
Lab Director JENNIFER V. NEMICH

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