18D2130897 CLIA NUMBER - WALMART / SAM'S CLUB PHARMACY 10-4908

Laboratory Demographics

  • CLIA Code: 18D2130897
  • Facility Name: WALMART / SAM'S CLUB PHARMACY 10-4908
  • Facility Address: 5240 FREDERICA ST
    OWENSBORO, KY
    ZIP 42301
  • Facility Phone: 479 277-1039
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. ROBERT L. KENNEDY
  • NPI Number: 1811914237
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2130897
LAB Type Pharmacy
Facility Name WALMART / SAM'S CLUB PHARMACY 10-4908
Street 5240 FREDERICA ST
City OWENSBORO
State KY
ZIP 42301
Phone 479 277-1039
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/18/2025
Certificate Expiration Date 5/17/2027
Facility Type Pharmacy
Lab Director MR. ROBERT L. KENNEDY

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This page was last updated on: 6/4/2025