50D2174657 CLIA NUMBER - WALMART PHARMACY #10-3217

Laboratory Demographics

  • CLIA Code: 50D2174657
  • Facility Name: WALMART PHARMACY #10-3217
  • Facility Address: 1860 E MAIN ST
    OTHELLO, WA
    ZIP 99344
  • Facility Phone: 509 488-9324
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SRINIVASA T. REPALLE
  • NPI Number: 1477570505
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2174657
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-3217
Street 1860 E MAIN ST
City OTHELLO
State WA
ZIP 99344
Phone 509 488-9324
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2019
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SRINIVASA T. REPALLE

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