21D2159467 CLIA NUMBER - WALMART PHARMACY 10-2027

Laboratory Demographics

  • CLIA Code: 21D2159467
  • Facility Name: WALMART PHARMACY 10-2027
  • Facility Address: 12500 COUNTRY CLUB MALL ROAD
    LAVALE, MD
    ZIP 21502
  • Facility Phone: 301 729-5088
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHAWN A. OPEL
  • NPI Number: 1114944493
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2159467
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2027
Street 12500 COUNTRY CLUB MALL ROAD
City LAVALE
State MD
ZIP 21502
Phone 301 729-5088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Pharmacy
Lab Director SHAWN A. OPEL

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