26D2143246 CLIA NUMBER - WALMART PHARMACY 10-29

Laboratory Demographics

  • CLIA Code: 26D2143246
  • Facility Name: WALMART PHARMACY 10-29
  • Facility Address: 724 STADIUM WEST BOULEVARD
    JEFFERSON CITY, MO
    ZIP 65109
  • Facility Phone: 479 277-2374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAYLOR TUEPKER
  • NPI Number: 1952329427
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2143246
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-29
Street 724 STADIUM WEST BOULEVARD
City JEFFERSON CITY
State MO
ZIP 65109
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 TAYLOR TUEPKER

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