24D2153885 CLIA NUMBER - WALMART PHARMACY 10-3806

Laboratory Demographics

  • CLIA Code: 24D2153885
  • Facility Name: WALMART PHARMACY 10-3806
  • Facility Address: 1250 GOEMANN RD
    FAIRMONT, MN
    ZIP 56031
  • Facility Phone: 507 235-2517
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASMINE STEPHAN
  • NPI Number: 1316146269
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2153885
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3806
Street 1250 GOEMANN RD
City FAIRMONT
State MN
ZIP 56031
Phone 507 235-2517
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Pharmacy
Lab Director JASMINE STEPHAN

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