43D2155103 CLIA NUMBER - WALMART PHARMACY 10-3734

Laboratory Demographics

  • CLIA Code: 43D2155103
  • Facility Name: WALMART PHARMACY 10-3734
  • Facility Address: 1207 PRINCETON AVE
    VERMILLION, SD
    ZIP 57069
  • Facility Phone: 605 624-4106
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KALEB CROWNOVER
  • NPI Number: 1487671657
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 43D2155103
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3734
Street 1207 PRINCETON AVE
City VERMILLION
State SD
ZIP 57069
Phone 605 624-4106
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/24/2024
Certificate Expiration Date 9/23/2026
Facility Type Pharmacy
Lab Director KALEB CROWNOVER

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