32D2133831 CLIA NUMBER - WALMART PHARMACY 10-2656

Laboratory Demographics

  • CLIA Code: 32D2133831
  • Facility Name: WALMART PHARMACY 10-2656
  • Facility Address: 1610 N RIVERSIDE DR
    ESPANOLA, NM
    ZIP 87532
  • Facility Phone: 505 747-0427
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIMON R. AKUM
  • NPI Number: 1053339754
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 32D2133831
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2656
Street 1610 N RIVERSIDE DR
City ESPANOLA
State NM
ZIP 87532
Phone 505 747-0427
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director SIMON R. AKUM

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