42D2174272 CLIA NUMBER - WALMART PHARMACY 10-1183

Laboratory Demographics

  • CLIA Code: 42D2174272
  • Facility Name: WALMART PHARMACY 10-1183
  • Facility Address: 2401 AUGUSTA RD
    WEST COLUMBIA, SC
    ZIP 29169
  • Facility Phone: 803 791-8114
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. RAEGAN S. KENNEDY
  • NPI Number: 1619994860
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2174272
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1183
Street 2401 AUGUSTA RD
City WEST COLUMBIA
State SC
ZIP 29169
Phone 803 791-8114
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 MS. RAEGAN S. KENNEDY

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