21D2158584 CLIA NUMBER - WALMART PHARMACY 10-1716

Laboratory Demographics

  • CLIA Code: 21D2158584
  • Facility Name: WALMART PHARMACY 10-1716
  • Facility Address: 150 SOLOMONS ISLAND ROAD N
    PRINCE FREDERICK, MD
    ZIP 20678
  • Facility Phone: 410 535-5552
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONSTANCE M. TAZEM
  • NPI Number: 1992722268
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2158584
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1716
Street 150 SOLOMONS ISLAND ROAD N
City PRINCE FREDERICK
State MD
ZIP 20678
Phone 410 535-5552
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 CONSTANCE M. TAZEM

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