17D2164804 CLIA NUMBER - WALMART PHARMACY 10-652

Laboratory Demographics

  • CLIA Code: 17D2164804
  • Facility Name: WALMART PHARMACY 10-652
  • Facility Address: 3101 E KANSAS AVE
    GARDEN CITY, KS
    ZIP 67846
  • Facility Phone: 620 275-7557
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEITH VEN JOHN
  • NPI Number: 1659398055
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2164804
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-652
Street 3101 E KANSAS AVE
City GARDEN CITY
State KS
ZIP 67846
Phone 620 275-7557
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 KEITH VEN JOHN

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