23D2097536 CLIA NUMBER - WALMART PHARMACY 10-3453

Laboratory Demographics

  • CLIA Code: 23D2097536
  • Facility Name: WALMART PHARMACY 10-3453
  • Facility Address: 355 54TH STREET SW
    WYOMING, MI
    ZIP 49548
  • Facility Phone: 616 552-6226
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CRAIG A. DOUGLAS
  • NPI Number: 1942612874
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2097536
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3453
Street 355 54TH STREET SW
City WYOMING
State MI
ZIP 49548
Phone 616 552-6226
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2025
Certificate Expiration Date 6/17/2027
Facility Type Pharmacy
Lab Director CRAIG A. DOUGLAS

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