23D2149448 CLIA NUMBER - WALMART PHARMACY 10-2062

Laboratory Demographics

  • CLIA Code: 23D2149448
  • Facility Name: WALMART PHARMACY 10-2062
  • Facility Address: 1400 MALL DRIVE
    BENTON HARBOR, MI
    ZIP 49022
  • Facility Phone: 269 927-6514
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMR A. ELBANNA
  • NPI Number: 1376560581
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149448
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2062
Street 1400 MALL DRIVE
City BENTON HARBOR
State MI
ZIP 49022
Phone 269 927-6514
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 AMR A. ELBANNA

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