26D2125345 CLIA NUMBER - WALMART STORES EAST LP DBA

Laboratory Demographics

  • CLIA Code: 26D2125345
  • Facility Name: WALMART STORES EAST LP DBA
  • Facility Address: 2206 N BALTIMORE ST
    KIRKSVILLE, MO
    ZIP 63501
  • Facility Phone: 660 627-1297
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRADLEY L. POLOVICH
  • NPI Number: 1144247461
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2125345
LAB Type Pharmacy
Facility Name WALMART STORES EAST LP DBA
Street 2206 N BALTIMORE ST
City KIRKSVILLE
State MO
ZIP 63501
Phone 660 627-1297
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type Pharmacy
Lab Director BRADLEY L. POLOVICH

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