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42D2181866 CLIA NUMBER - WALMART PHARMACY 10-4664

Laboratory Demographics

CLIA Number: 42D2181866

Facility Name: WALMART PHARMACY 10-4664

Facility Address:
151 MYRTLE RIDGE DRIVE
CONWAY, SC
ZIP 29526
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Facility Phone Number: 843 234-1420

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1659916344

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 42D2181866
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4664
Street 151 MYRTLE RIDGE DRIVE
City CONWAY
State SC
ZIP 29526
Phone 843 234-1420
CertificateType 4
CertificateEffectiveDate 4/13/2024
CertificateExpirationDate 4/12/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024