49D2143897 CLIA NUMBER - WALMART PHARMACY 10-1825

Laboratory Demographics

  • CLIA Code: 49D2143897
  • Facility Name: WALMART PHARMACY 10-1825
  • Facility Address: 8386 SUDLEY ROAD
    MANASSAS, VA
    ZIP 20109
  • Facility Phone: 703 330-2455
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUEBANG D. KENMATO
  • NPI Number: 1285651380
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2143897
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1825
Street 8386 SUDLEY ROAD
City MANASSAS
State VA
ZIP 20109
Phone 703 330-2455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Pharmacy
Lab Director SUEBANG D. KENMATO

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