23D2149508 CLIA NUMBER - WALMART PHARMACY 10-5376

Laboratory Demographics

  • CLIA Code: 23D2149508
  • Facility Name: WALMART PHARMACY 10-5376
  • Facility Address: 621 E LAKE STREET
    TAWAS CITY, MI
    ZIP 48763
  • Facility Phone: 989 984-0924
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELISABETH N. WYGANT
  • NPI Number: 1457378820
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149508
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5376
Street 621 E LAKE STREET
City TAWAS CITY
State MI
ZIP 48763
Phone 989 984-0924
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 ELISABETH N. WYGANT

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