18D2138739 CLIA NUMBER - WALMART PHARMACY 4450

Laboratory Demographics

  • CLIA Code: 18D2138739
  • Facility Name: WALMART PHARMACY 4450
  • Facility Address: 12981 SHELBYVILLE ROAD
    MIDDLETOWN, KY
    ZIP 40243
  • Facility Phone: 479 277-1039
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. NICHOLAS R. TRZUSKUS
  • NPI Number: 1831390251
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2138739
LAB Type Pharmacy
Facility Name WALMART PHARMACY 4450
Street 12981 SHELBYVILLE ROAD
City MIDDLETOWN
State KY
ZIP 40243
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 10/24/2023
Certificate Expiration Date 10/23/2025
Facility Type Pharmacy
Lab Director MR. NICHOLAS R. TRZUSKUS

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