23D2149431 CLIA NUMBER - WALMART PHARMACY 10-1540

Laboratory Demographics

  • CLIA Code: 23D2149431
  • Facility Name: WALMART PHARMACY 10-1540
  • Facility Address: 201 73RD STREET
    SOUTH HAVEN, MI
    ZIP 49090
  • Facility Phone: 269 637-7802
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SEAN SOMERS
  • NPI Number: 1093732307
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149431
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1540
Street 201 73RD STREET
City SOUTH HAVEN
State MI
ZIP 49090
Phone 269 637-7802
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2024
Certificate Expiration Date 6/4/2026
Facility Type Pharmacy
Lab Director SEAN SOMERS

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