50D2175099 CLIA NUMBER - WALMART PHARMACY #10-2249

Laboratory Demographics

  • CLIA Code: 50D2175099
  • Facility Name: WALMART PHARMACY #10-2249
  • Facility Address: 1601 NW LOUISIANA AVE
    CHEHALIS, WA
    ZIP 98532
  • Facility Phone: 360 748-0858
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL MARDINI
  • NPI Number: 1407209505
  • Taxonomy: 251S00000X - Community/Behavioral Health

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CLIA Record

Field Name Field Value
CLIA Number 50D2175099
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2249
Street 1601 NW LOUISIANA AVE
City CHEHALIS
State WA
ZIP 98532
Phone 360 748-0858
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2019
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director SAMUEL MARDINI

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This page was last updated on: 6/4/2025