23D2149551 CLIA NUMBER - WALMART PHARMACY 10-1719

Laboratory Demographics

  • CLIA Code: 23D2149551
  • Facility Name: WALMART PHARMACY 10-1719
  • Facility Address: 21400 PERRY AVENUE
    BIG RAPIDS, MI
    ZIP 49307
  • Facility Phone: 231 796-3691
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY S. VANDAM
  • NPI Number: 1457378762
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2149551
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1719
Street 21400 PERRY AVENUE
City BIG RAPIDS
State MI
ZIP 49307
Phone 231 796-3691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2024
Certificate Expiration Date 6/5/2026
Facility Type Pharmacy
Lab Director ANTHONY S. VANDAM

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