17D2167029 CLIA NUMBER - WAL-MART PHARMACY 03492

Laboratory Demographics

  • CLIA Code: 17D2167029
  • Facility Name: WAL-MART PHARMACY 03492
  • Facility Address: 11411 EAST KELLOGG DR
    WICHITA, KS
    ZIP 67207
  • Facility Phone: 316 683-8463
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BINH K. LY
  • NPI Number: 1821015249
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2167029
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY 03492
Street 11411 EAST KELLOGG DR
City WICHITA
State KS
ZIP 67207
Phone 316 683-8463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/31/2025
Certificate Expiration Date 5/30/2027
Facility Type Pharmacy
Lab Director BINH K. LY

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