20D2156746 CLIA NUMBER - WALMART PHARMACY 10-01788

Laboratory Demographics

  • CLIA Code: 20D2156746
  • Facility Name: WALMART PHARMACY 10-01788
  • Facility Address: 500 GALLERY BLVD
    SCARBOROUGH, ME
    ZIP 04074
  • Facility Phone: 207 885-5191
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PETER D. KOMBAKIS
  • NPI Number: 1225055593
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2156746
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-01788
Street 500 GALLERY BLVD
City SCARBOROUGH
State ME
ZIP 04074
Phone 207 885-5191
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 PETER D. KOMBAKIS

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