42D2181942 CLIA NUMBER - WALMART PHARMACY 10-3724

Laboratory Demographics

  • CLIA Code: 42D2181942
  • Facility Name: WALMART PHARMACY 10-3724
  • Facility Address: 332 STONE WALL JACKSON BLVD
    ORANGEBURG, SC
    ZIP 29115
  • Facility Phone: 803 997-6138
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORDAN A. PATRICK
  • NPI Number: 1477957397
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2181942
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3724
Street 332 STONE WALL JACKSON BLVD
City ORANGEBURG
State SC
ZIP 29115
Phone 803 997-6138
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2024
Certificate Expiration Date 4/13/2026
Facility Type Pharmacy
Lab Director JORDAN A. PATRICK

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