44D2140391 CLIA NUMBER - WALMART PHARMACY 10-0673

Laboratory Demographics

  • CLIA Code: 44D2140391
  • Facility Name: WALMART PHARMACY 10-0673
  • Facility Address: 3050 WILMA RUDOLPH BLVD
    CLARKSVILLE, TN
    ZIP 37040
  • Facility Phone: 931 552-0241
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORDAN IVE
  • NPI Number: 1831116003
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D2140391
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0673
Street 3050 WILMA RUDOLPH BLVD
City CLARKSVILLE
State TN
ZIP 37040
Phone 931 552-0241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Pharmacy
Lab Director JORDAN IVE

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