22D2169340 CLIA NUMBER - WALMART PHARMACY 10- 1967

Laboratory Demographics

  • CLIA Code: 22D2169340
  • Facility Name: WALMART PHARMACY 10- 1967
  • Facility Address: 1105 BOSTON ROAD
    SPRINGFIELD, MA
    ZIP 01119
  • Facility Phone: 413 782-6897
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DARREN M. LEBEAU
  • NPI Number: 1194742486
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 22D2169340
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10- 1967
Street 1105 BOSTON ROAD
City SPRINGFIELD
State MA
ZIP 01119
Phone 413 782-6897
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 DARREN M. LEBEAU

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