28D2160111 CLIA NUMBER - WALMART PHARMACY #867

Laboratory Demographics

  • CLIA Code: 28D2160111
  • Facility Name: WALMART PHARMACY #867
  • Facility Address: 3322 AVENUE I
    SCOTTSBLUFF, NE
    ZIP 69361
  • Facility Phone: 308 632-3767
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL A. CALVERT
  • NPI Number: 1972686434
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 28D2160111
LAB Type Pharmacy
Facility Name WALMART PHARMACY #867
Street 3322 AVENUE I
City SCOTTSBLUFF
State NE
ZIP 69361
Phone 308 632-3767
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Pharmacy
Lab Director MICHAEL A. CALVERT

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