34D2139270 CLIA NUMBER - WALMART PHARMACY 10-1767

Laboratory Demographics

  • CLIA Code: 34D2139270
  • Facility Name: WALMART PHARMACY 10-1767
  • Facility Address: 4540 MAIN ST B 3079
    SHALLOTTE, NC
    ZIP 28459
  • Facility Phone: 910 754-2885
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ATHAN S. VRETTOS
  • NPI Number: 1356369151
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2139270
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1767
Street 4540 MAIN ST B 3079
City SHALLOTTE
State NC
ZIP 28459
Phone 910 754-2885
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2023
Certificate Expiration Date 10/31/2025
Facility Type Pharmacy
Lab Director ATHAN S. VRETTOS

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