21D2158582 CLIA NUMBER - WALMART PHARMACY 10-5382

Laboratory Demographics

  • CLIA Code: 21D2158582
  • Facility Name: WALMART PHARMACY 10-5382
  • Facility Address: 8107 GOVERNOR RITCHIE HIGHWAY
    PASADENA, MD
    ZIP 21122
  • Facility Phone: 410 689-1508
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHOUNG HA
  • NPI Number: 1801279062
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2158582
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5382
Street 8107 GOVERNOR RITCHIE HIGHWAY
City PASADENA
State MD
ZIP 21122
Phone 410 689-1508
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 PHOUNG HA

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