18D2143191 CLIA NUMBER - WAL-MART PHARMACY #10-696

Laboratory Demographics

  • CLIA Code: 18D2143191
  • Facility Name: WAL-MART PHARMACY #10-696
  • Facility Address: 477 VILLAGE DR
    PRESTONSBURG, KY
    ZIP 41653
  • Facility Phone: 606 886-1100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. JIMMY OSBORNE
  • NPI Number: 1992722318
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2143191
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-696
Street 477 VILLAGE DR
City PRESTONSBURG
State KY
ZIP 41653
Phone 606 886-1100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type Pharmacy
Lab Director MR. JIMMY OSBORNE

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