34D2139374 CLIA NUMBER - WALMART PHARMACY 10-7004

Laboratory Demographics

  • CLIA Code: 34D2139374
  • Facility Name: WALMART PHARMACY 10-7004
  • Facility Address: 1300 DALLAS CHERRYVILLE ROAD
    DALLAS, NC
    ZIP 28034
  • Facility Phone: 704 648-0914
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACOBUS V. DODOO
  • NPI Number: 1609283688
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2139374
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-7004
Street 1300 DALLAS CHERRYVILLE ROAD
City DALLAS
State NC
ZIP 28034
Phone 704 648-0914
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Pharmacy
Lab Director JACOBUS V. DODOO

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