42D2181872 CLIA NUMBER - WALMART PHARMACY 10-396

Laboratory Demographics

  • CLIA Code: 42D2181872
  • Facility Name: WALMART PHARMACY 10-396
  • Facility Address: 3812 LIBERTY HWY
    ANDERSON, SC
    ZIP 29621
  • Facility Phone: 864 231-6071
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY ELIZABETH F. JACSON
  • NPI Number: 1750785127
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 42D2181872
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-396
Street 3812 LIBERTY HWY
City ANDERSON
State SC
ZIP 29621
Phone 864 231-6071
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2024
Certificate Expiration Date 4/12/2026
Facility Type Pharmacy
Lab Director MARY ELIZABETH F. JACSON

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