47D2121414 CLIA NUMBER - WAL-MART STORES INC D/B/A WALMART PHARMACY 10-4156

Laboratory Demographics

  • CLIA Code: 47D2121414
  • Facility Name: WAL-MART STORES INC D/B/A WALMART PHARMACY 10-4156
  • Facility Address: 115 SEYMOUR DR
    DERBY, VT
    ZIP 05829
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE WHITEHOUSE
  • NPI Number: 1588112809
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 47D2121414
LAB Type Pharmacy
Facility Name WAL-MART STORES INC D/B/A WALMART PHARMACY 10-4156
Street 115 SEYMOUR DR
City DERBY
State VT
ZIP 05829
Phone 479 258-6734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2024
Certificate Expiration Date 11/3/2026
Facility Type Pharmacy
Lab Director STEPHANIE WHITEHOUSE

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