23D2149504 CLIA NUMBER - WALMART PHARMACY 10-4439

Laboratory Demographics

  • CLIA Code: 23D2149504
  • Facility Name: WALMART PHARMACY 10-4439
  • Facility Address: 1013 S KALAMAZOO STREET
    PAW PAW, MI
    ZIP 49079
  • Facility Phone: 269 415-6014
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANKAR T. SUBBIAH
  • NPI Number: 1093132003
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149504
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4439
Street 1013 S KALAMAZOO STREET
City PAW PAW
State MI
ZIP 49079
Phone 269 415-6014
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 SHANKAR T. SUBBIAH

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