37D2154274 CLIA NUMBER - WALMART PHARMACY 10-136

Laboratory Demographics

  • CLIA Code: 37D2154274
  • Facility Name: WALMART PHARMACY 10-136
  • Facility Address: 1219 W DOOLIN AVE
    BLACKWELL, OK
    ZIP 74631
  • Facility Phone: 580 363-4090
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER E. PRATER
  • NPI Number: 1699792713
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2154274
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-136
Street 1219 W DOOLIN AVE
City BLACKWELL
State OK
ZIP 74631
Phone 580 363-4090
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Pharmacy
Lab Director JENNIFER E. PRATER

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