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26D2144269 CLIA NUMBER - WALMART PHARMACY 10- 152

Laboratory Demographics

CLIA Number: 26D2144269

Facility Name: WALMART PHARMACY 10- 152

Facility Address:
12862 STATE ROUTE 21
DE SOTO, MO
ZIP 63020
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Facility Phone Number: 479 277-2374

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1467470963

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 26D2144269
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10- 152
Street 12862 STATE ROUTE 21
City DE SOTO
State MO
ZIP 63020
Phone 479 277-2374
CertificateType 4
CertificateEffectiveDate 2/13/2024
CertificateExpirationDate 2/12/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024