50D2174659 CLIA NUMBER - WALMART PHARMACY 10-5041

Laboratory Demographics

  • CLIA Code: 50D2174659
  • Facility Name: WALMART PHARMACY 10-5041
  • Facility Address: 19205 STATE ROUTE 410 E
    BONNEY LAKE, WA
    ZIP 98391
  • Facility Phone: 253 826-9151
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ONYII NWUDE-EZEKEKE
  • NPI Number: 1730106865
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2174659
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5041
Street 19205 STATE ROUTE 410 E
City BONNEY LAKE
State WA
ZIP 98391
Phone 253 826-9151
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 ONYII NWUDE-EZEKEKE

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