22D2169305 CLIA NUMBER - WALMART PHARMACY 10- 1906

Laboratory Demographics

  • CLIA Code: 22D2169305
  • Facility Name: WALMART PHARMACY 10- 1906
  • Facility Address: 42 FAIRHAVEN COMMONS WAY
    FAIRHAVEN, MA
    ZIP 02719
  • Facility Phone: 508 993-4250
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEN WEN HSU-YIN
  • NPI Number: 1649436387
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 22D2169305
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10- 1906
Street 42 FAIRHAVEN COMMONS WAY
City FAIRHAVEN
State MA
ZIP 02719
Phone 508 993-4250
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 JEN WEN HSU-YIN

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