28D2164841 CLIA NUMBER - WALMART PHARMACY 10-4209

Laboratory Demographics

  • CLIA Code: 28D2164841
  • Facility Name: WALMART PHARMACY 10-4209
  • Facility Address: 2101 S 11TH STREET
    NEBRASKA CITY, NE
    ZIP 68410
  • Facility Phone: 402 874-9093
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY D. BOUCKAERT
  • NPI Number: 1649335076
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2164841
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4209
Street 2101 S 11TH STREET
City NEBRASKA CITY
State NE
ZIP 68410
Phone 402 874-9093
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 TIMOTHY D. BOUCKAERT

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