23D2149504 CLIA NUMBER - WALMART PHARMACY 10-4439

Laboratory Demographics

CLIA Number: 23D2149504

Facility Name: WALMART PHARMACY 10-4439

Facility Address:
1013 S KALAMAZOO STREET
PAW PAW, MI
ZIP 49079
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Facility Phone Number: 269 415-6014

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093132003

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	6/5/2022
CertificateExpirationDate	6/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024