22D2169290 CLIA NUMBER - WALMART PHARMACY 10- 4387

Laboratory Demographics

  • CLIA Code: 22D2169290
  • Facility Name: WALMART PHARMACY 10- 4387
  • Facility Address: 25 TOBIAS BOLAND WAY
    WORCESTER, MA
    ZIP 01607
  • Facility Phone: 774 314-3162
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KARA MANCHESTER
  • NPI Number: 1740503051
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 22D2169290
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10- 4387
Street 25 TOBIAS BOLAND WAY
City WORCESTER
State MA
ZIP 01607
Phone 774 314-3162
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/18/2025
Certificate Expiration Date 7/17/2027
Facility Type Pharmacy
Lab Director KARA MANCHESTER

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