42D2174269 CLIA NUMBER - WALMART PHARMACY 10-585

Laboratory Demographics

  • CLIA Code: 42D2174269
  • Facility Name: WALMART PHARMACY 10-585
  • Facility Address: 2377 DAVE LYLE BLVD
    ROCK HILL, SC
    ZIP 29730
  • Facility Phone: 803 366-8191
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASMIN HICKLEN
  • NPI Number: 1568489722
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2174269
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-585
Street 2377 DAVE LYLE BLVD
City ROCK HILL
State SC
ZIP 29730
Phone 803 366-8191
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 JASMIN HICKLEN

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