24D2153896 CLIA NUMBER - WALMART PHARMACY 10-1634

Laboratory Demographics

  • CLIA Code: 24D2153896
  • Facility Name: WALMART PHARMACY 10-1634
  • Facility Address: 15091 18TH STREET NE
    LITTLE FALLS, MN
    ZIP 56345
  • Facility Phone: 320 632-3644
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JERRON BOSER
  • NPI Number: 1083631451
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2153896
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1634
Street 15091 18TH STREET NE
City LITTLE FALLS
State MN
ZIP 56345
Phone 320 632-3644
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 JERRON BOSER

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This page was last updated on: 3/20/2025