36D2157806 CLIA NUMBER - WALMART PHARMACY #10-5104

Laboratory Demographics

  • CLIA Code: 36D2157806
  • Facility Name: WALMART PHARMACY #10-5104
  • Facility Address: 1701 W DOROTHY LANE
    MORAINE, OH
    ZIP 45439
  • Facility Phone: 937 643-2481
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALIA SHABAN
  • NPI Number: 1912085978
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 36D2157806
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-5104
Street 1701 W DOROTHY LANE
City MORAINE
State OH
ZIP 45439
Phone 937 643-2481
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Pharmacy
Lab Director ALIA SHABAN

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