23D2149458 CLIA NUMBER - WALMART PHARMACY 10-2493

Laboratory Demographics

  • CLIA Code: 23D2149458
  • Facility Name: WALMART PHARMACY 10-2493
  • Facility Address: 5859 28TH STREET SE
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 949-9892
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RANDALL S. SAMYN
  • NPI Number: 1366469579
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149458
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2493
Street 5859 28TH STREET SE
City GRAND RAPIDS
State MI
ZIP 49546
Phone 616 949-9892
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 RANDALL S. SAMYN

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