28D2129380 CLIA NUMBER - WALMART PHARMACY 10-1332

Laboratory Demographics

  • CLIA Code: 28D2129380
  • Facility Name: WALMART PHARMACY 10-1332
  • Facility Address: 1601 CORNHUSKER DRIVE
    SOUTH SIOUX CITY, NE
    ZIP 68776
  • Facility Phone: 402 494-8850
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THO T. PROFERA
  • NPI Number: 1336245521
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 28D2129380
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1332
Street 1601 CORNHUSKER DRIVE
City SOUTH SIOUX CITY
State NE
ZIP 68776
Phone 402 494-8850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2025
Certificate Expiration Date 4/17/2027
Facility Type Pharmacy
Lab Director THO T. PROFERA

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