21D2157585 CLIA NUMBER - WALMART PHARMACY

Laboratory Demographics

  • CLIA Code: 21D2157585
  • Facility Name: WALMART PHARMACY
  • Facility Address: 6420 PETRIE WAY ROAD
    BALTIMORE, MD
    ZIP 21237
  • Facility Phone: 410 687-6832
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY WOANYA
  • NPI Number: 1487671772
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2157585
LAB Type Pharmacy
Facility Name WALMART PHARMACY
Street 6420 PETRIE WAY ROAD
City BALTIMORE
State MD
ZIP 21237
Phone 410 687-6832
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Pharmacy
Lab Director ANTHONY WOANYA

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