23D2129638 CLIA NUMBER - WALMART PHARMACY 10-5411

Laboratory Demographics

  • CLIA Code: 23D2129638
  • Facility Name: WALMART PHARMACY 10-5411
  • Facility Address: 152 W SPRAGUE ROAD
    IONIA, MI
    ZIP 48846
  • Facility Phone: 616 527-3904
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GEOFFREY GRACE
  • NPI Number: 1366469736
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2129638
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5411
Street 152 W SPRAGUE ROAD
City IONIA
State MI
ZIP 48846
Phone 616 527-3904
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Pharmacy
Lab Director GEOFFREY GRACE

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