42D2174273 CLIA NUMBER - WALMART PHARMACY 10-627

Laboratory Demographics

  • CLIA Code: 42D2174273
  • Facility Name: WALMART PHARMACY 10-627
  • Facility Address: 805 ENTERPRISE ROAD
    DILLON, SC
    ZIP 29536
  • Facility Phone: 843 841-2228
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL J. SPIVEY
  • NPI Number: 1821015082
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2174273
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-627
Street 805 ENTERPRISE ROAD
City DILLON
State SC
ZIP 29536
Phone 843 841-2228
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 DANIEL J. SPIVEY

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