50D2174952 CLIA NUMBER - WALMART PHARMACY #10-2121

Laboratory Demographics

  • CLIA Code: 50D2174952
  • Facility Name: WALMART PHARMACY #10-2121
  • Facility Address: 100 E WALLACE KNEELAND BLVD
    SHELTON, WA
    ZIP 98584
  • Facility Phone: 360 427-0171
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BROOKE HENNINGER
  • NPI Number: 1699793356
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2174952
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2121
Street 100 E WALLACE KNEELAND BLVD
City SHELTON
State WA
ZIP 98584
Phone 360 427-0171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2019
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director BROOKE HENNINGER

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