20D2156743 CLIA NUMBER - WALMART PHARMACY #10-1856

Laboratory Demographics

  • CLIA Code: 20D2156743
  • Facility Name: WALMART PHARMACY #10-1856
  • Facility Address: 900 STILLWATER AVE
    BANGOR, ME
    ZIP 04401
  • Facility Phone: 207 947-5811
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSHUA PRUE PHARM D
  • NPI Number: 1003833377
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2156743
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1856
Street 900 STILLWATER AVE
City BANGOR
State ME
ZIP 04401
Phone 207 947-5811
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2024
Certificate Expiration Date 10/23/2026
Facility Type Pharmacy
Lab Director JOSHUA PRUE PHARM D

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