36D2157814 CLIA NUMBER - WALMART PHARMACY #10-2124

Laboratory Demographics

  • CLIA Code: 36D2157814
  • Facility Name: WALMART PHARMACY #10-2124
  • Facility Address: 3360 PENTAGON BLVD
    BEAVERCREEK, OH
    ZIP 45431
  • Facility Phone: 937 426-8227
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DORAE C. BUSH
  • NPI Number: 1720005911
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2157814
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2124
Street 3360 PENTAGON BLVD
City BEAVERCREEK
State OH
ZIP 45431
Phone 937 426-8227
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 DORAE C. BUSH

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