26D2144573 CLIA NUMBER - WALMART PHARMACY 10 - 805

Laboratory Demographics

  • CLIA Code: 26D2144573
  • Facility Name: WALMART PHARMACY 10 - 805
  • Facility Address: 653 GRAVOIS BLUFFS BOULEVARD
    FENTON, MO
    ZIP 63026
  • Facility Phone: 479 277-2374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTINA S. PARK
  • NPI Number: 1780601039
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 26D2144573
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10 - 805
Street 653 GRAVOIS BLUFFS BOULEVARD
City FENTON
State MO
ZIP 63026
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 2/20/2024
Certificate Expiration Date 2/19/2026
Facility Type Pharmacy
Lab Director KRISTINA S. PARK

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