47D2129471 CLIA NUMBER - WALMART PHARMACY 10-2224

Laboratory Demographics

  • CLIA Code: 47D2129471
  • Facility Name: WALMART PHARMACY 10-2224
  • Facility Address: 863 HARVEST LN
    WILLISTON, VT
    ZIP 05495
  • Facility Phone: 802 878-5533
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANE BRICHACEK
  • NPI Number: 1518984715
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 47D2129471
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2224
Street 863 HARVEST LN
City WILLISTON
State VT
ZIP 05495
Phone 802 878-5533
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director SHANE BRICHACEK

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