26D2143243 CLIA NUMBER - WALMART PHARMACY 1-65

Laboratory Demographics

  • CLIA Code: 26D2143243
  • Facility Name: WALMART PHARMACY 1-65
  • Facility Address: 350 PARK RIDGE ROAD
    SULLIVAN, MO
    ZIP 63080
  • Facility Phone: 479 277-2374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRENEE KOCH
  • NPI Number: 1780601005
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2143243
LAB Type Pharmacy
Facility Name WALMART PHARMACY 1-65
Street 350 PARK RIDGE ROAD
City SULLIVAN
State MO
ZIP 63080
Phone 479 277-2374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2024
Certificate Expiration Date 1/25/2026
Facility Type Pharmacy
Lab Director TRENEE KOCH

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