22D2169302 CLIA NUMBER - WALMART PHARMACY 10- 2904

Laboratory Demographics

  • CLIA Code: 22D2169302
  • Facility Name: WALMART PHARMACY 10- 2904
  • Facility Address: 700 OAK STREET
    BROCKTON, MA
    ZIP 02301
  • Facility Phone: 508 584-5955
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEROME SALWIERZ
  • NPI Number: 1568489870
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 22D2169302
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10- 2904
Street 700 OAK STREET
City BROCKTON
State MA
ZIP 02301
Phone 508 584-5955
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 JEROME SALWIERZ

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