37D2153383 CLIA NUMBER - WALMART PHARMACY 10-823

Laboratory Demographics

  • CLIA Code: 37D2153383
  • Facility Name: WALMART PHARMACY 10-823
  • Facility Address: 1101 E PROSPECT AVE
    PONCA CITY, OK
    ZIP 74601
  • Facility Phone: 580 765-0152
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTINE J. MATKIN
  • NPI Number: 1134146251
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2153383
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-823
Street 1101 E PROSPECT AVE
City PONCA CITY
State OK
ZIP 74601
Phone 580 765-0152
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2024
Certificate Expiration Date 8/23/2026
Facility Type Pharmacy
Lab Director CHRISTINE J. MATKIN

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