21D2160800 CLIA NUMBER - WALMART PHARMACY 10-1875

Laboratory Demographics

  • CLIA Code: 21D2160800
  • Facility Name: WALMART PHARMACY 10-1875
  • Facility Address: 407 GEORGE CLAUS BOULEVARD
    SEVERN, MD
    ZIP 21144
  • Facility Phone: 410 582-9335
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUKWUKA S. DIMONYE
  • NPI Number: 1942381314
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 21D2160800
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1875
Street 407 GEORGE CLAUS BOULEVARD
City SEVERN
State MD
ZIP 21144
Phone 410 582-9335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Pharmacy
Lab Director CHUKWUKA S. DIMONYE

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