42D2181949 CLIA NUMBER - WALMART PHARMACY 10-5745

Laboratory Demographics

  • CLIA Code: 42D2181949
  • Facility Name: WALMART PHARMACY 10-5745
  • Facility Address: 175 HIGHWAY 274
    LAKE WYLIE, SC
    ZIP 29710
  • Facility Phone: 803 831-5078
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIN GRANDORFF
  • NPI Number: 1922479559
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 42D2181949
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5745
Street 175 HIGHWAY 274
City LAKE WYLIE
State SC
ZIP 29710
Phone 803 831-5078
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 ERIN GRANDORFF

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