49D2144011 CLIA NUMBER - WALMART PHARMACY 10-3639

Laboratory Demographics

  • CLIA Code: 49D2144011
  • Facility Name: WALMART PHARMACY 10-3639
  • Facility Address: 24635 DULLES LANDING DRIVE
    DULLES, VA
    ZIP 20166
  • Facility Phone: 571 367-3038
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VENKATESHWAR BASANI
  • NPI Number: 1609254960
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2144011
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3639
Street 24635 DULLES LANDING DRIVE
City DULLES
State VA
ZIP 20166
Phone 571 367-3038
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2024
Certificate Expiration Date 2/7/2026
Facility Type Pharmacy
Lab Director VENKATESHWAR BASANI

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