28D2160114 CLIA NUMBER - WALMART PHARMACY 10-3173

Laboratory Demographics

  • CLIA Code: 28D2160114
  • Facility Name: WALMART PHARMACY 10-3173
  • Facility Address: 9460 GILES ROAD
    LA VISTA, NE
    ZIP 68128
  • Facility Phone: 402 513-4214
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLBY S. HOLYOAK
  • NPI Number: 1376977223
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2160114
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3173
Street 9460 GILES ROAD
City LA VISTA
State NE
ZIP 68128
Phone 402 513-4214
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 COLBY S. HOLYOAK

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