17D2167054 CLIA NUMBER - WALMART PHARMACY #5308

Laboratory Demographics

  • CLIA Code: 17D2167054
  • Facility Name: WALMART PHARMACY #5308
  • Facility Address: 11010 W 74TH TER
    SHAWNEE, KS
    ZIP 66203
  • Facility Phone: 913 268-4012
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALLYSON M. MARCUSON
  • NPI Number: 1467479881
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 17D2167054
LAB Type Pharmacy
Facility Name WALMART PHARMACY #5308
Street 11010 W 74TH TER
City SHAWNEE
State KS
ZIP 66203
Phone 913 268-4012
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 ALLYSON M. MARCUSON

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