21D2158578 CLIA NUMBER - WALMART PHARMACY 10-2412

Laboratory Demographics

  • CLIA Code: 21D2158578
  • Facility Name: WALMART PHARMACY 10-2412
  • Facility Address: 3200 NORTH RIDGE ROAD
    ELLICOTT CITY, MD
    ZIP 21043
  • Facility Phone: 410 418-9703
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAULETTE M. GLOVER
  • NPI Number: 1013934397
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2158578
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2412
Street 3200 NORTH RIDGE ROAD
City ELLICOTT CITY
State MD
ZIP 21043
Phone 410 418-9703
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Pharmacy
Lab Director PAULETTE M. GLOVER

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