42D2174227 CLIA NUMBER - WALMART PHARMACY 10-632

Laboratory Demographics

  • CLIA Code: 42D2174227
  • Facility Name: WALMART PHARMACY 10-632
  • Facility Address: 1481 N HIGHWAY 17
    MOUNT PLEASANT, SC
    ZIP 29464
  • Facility Phone: 843 881-9585
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCIANA RONCON
  • NPI Number: 1396763116
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2174227
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-632
Street 1481 N HIGHWAY 17
City MOUNT PLEASANT
State SC
ZIP 29464
Phone 843 881-9585
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Pharmacy
Lab Director LUCIANA RONCON

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