50D2174798 CLIA NUMBER - WALMART PHARMACY #10-2241

Laboratory Demographics

  • CLIA Code: 50D2174798
  • Facility Name: WALMART PHARMACY #10-2241
  • Facility Address: 2675 E LINCOLN AVE
    SUNNYSIDE, WA
    ZIP 98944
  • Facility Phone: 509 839-7030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MASTAN RAMPRASAD GANGISETTI
  • NPI Number: 1477570596
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2174798
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2241
Street 2675 E LINCOLN AVE
City SUNNYSIDE
State WA
ZIP 98944
Phone 509 839-7030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2019
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director MASTAN RAMPRASAD GANGISETTI

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