28D2164840 CLIA NUMBER - WALMART PHARMACY 10-4139

Laboratory Demographics

  • CLIA Code: 28D2164840
  • Facility Name: WALMART PHARMACY 10-4139
  • Facility Address: 360 NORTH SADLECREEK ROAD
    OMAHA, NE
    ZIP 68131
  • Facility Phone: 402 970-6492
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THAO PHAN
  • NPI Number: 1023436573
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2164840
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4139
Street 360 NORTH SADLECREEK ROAD
City OMAHA
State NE
ZIP 68131
Phone 402 970-6492
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2025
Certificate Expiration Date 4/14/2027
Facility Type Pharmacy
Lab Director THAO PHAN

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