42D2174279 CLIA NUMBER - WALMART PHARMACY 10-621

Laboratory Demographics

  • CLIA Code: 42D2174279
  • Facility Name: WALMART PHARMACY 10-621
  • Facility Address: 900 US 52 HWY
    LAKE CITY, SC
    ZIP 29560
  • Facility Phone: 843 394-8125
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AUSTIN NEWELL
  • NPI Number: 1386661544
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2174279
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-621
Street 900 US 52 HWY
City LAKE CITY
State SC
ZIP 29560
Phone 843 394-8125
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 AUSTIN NEWELL

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