36D2172496 CLIA NUMBER - WALMART PHARMACY #10-1289

Laboratory Demographics

  • CLIA Code: 36D2172496
  • Facility Name: WALMART PHARMACY #10-1289
  • Facility Address: 2825 PROGRESS WAY
    WILMINGTON, OH
    ZIP 45177
  • Facility Phone: 937 382-5489
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL T. WILDERMUTH
  • NPI Number: 1275550451
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2172496
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1289
Street 2825 PROGRESS WAY
City WILMINGTON
State OH
ZIP 45177
Phone 937 382-5489
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2025
Certificate Expiration Date 9/23/2027
Facility Type Pharmacy
Lab Director MICHAEL T. WILDERMUTH

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