17D2167047 CLIA NUMBER - WALMART PHARMACY 10-341

Laboratory Demographics

  • CLIA Code: 17D2167047
  • Facility Name: WALMART PHARMACY 10-341
  • Facility Address: 1174 PONY EXPRESS HWY
    MARYSVILLE, KS
    ZIP 66508
  • Facility Phone: 785 562-3000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSANNE C. CARLSON
  • NPI Number: 1003833401
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2167047
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-341
Street 1174 PONY EXPRESS HWY
City MARYSVILLE
State KS
ZIP 66508
Phone 785 562-3000
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 SUSANNE C. CARLSON

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