24D2146589 CLIA NUMBER - WALMART PHARMACY 10-3513

Laboratory Demographics

  • CLIA Code: 24D2146589
  • Facility Name: WALMART PHARMACY 10-3513
  • Facility Address: 8101 OLD CARRIAGE CT
    SHAKOPEE, MN
    ZIP 55379
  • Facility Phone: 952 445-8058
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHILIP B. MOORE
  • NPI Number: 1538186937
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2146589
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3513
Street 8101 OLD CARRIAGE CT
City SHAKOPEE
State MN
ZIP 55379
Phone 952 445-8058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Pharmacy
Lab Director PHILIP B. MOORE

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