36D2170161 CLIA NUMBER - WALMART PHARMACY #10-5499

Laboratory Demographics

  • CLIA Code: 36D2170161
  • Facility Name: WALMART PHARMACY #10-5499
  • Facility Address: 201 CHAMBER DRIVE
    MILFORD, OH
    ZIP 45150
  • Facility Phone: 513 248-4284
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CORY A. SIMONAVICE
  • NPI Number: 1174657738
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2170161
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-5499
Street 201 CHAMBER DRIVE
City MILFORD
State OH
ZIP 45150
Phone 513 248-4284
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2025
Certificate Expiration Date 8/4/2027
Facility Type Pharmacy
Lab Director CORY A. SIMONAVICE

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