36D2172831 CLIA NUMBER - WALMART PHARMACY #10-1622

Laboratory Demographics

CLIA Number: 36D2172831

Facility Name: WALMART PHARMACY #10-1622

Facility Address:
2801 W STATE ROUTE 18
TIFFIN, OH
ZIP 44883
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Facility Phone Number: 419 448-4402

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1144248980

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	36D2172831
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY #10-1622
Street	2801 W STATE ROUTE 18
City	TIFFIN
State	OH
ZIP	44883
Phone	419 448-4402
CertificateType	4
CertificateEffectiveDate	10/1/2023
CertificateExpirationDate	9/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024