50D2175103 CLIA NUMBER - WALMART PHARMACY #10-3531

Laboratory Demographics

  • CLIA Code: 50D2175103
  • Facility Name: WALMART PHARMACY #10-3531
  • Facility Address: 1401 GALAXY DR NE
    LACEY, WA
    ZIP 98516
  • Facility Phone: 360 456-7862
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMMA BOBROVNIKOV
  • NPI Number: 1821015959
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2175103
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-3531
Street 1401 GALAXY DR NE
City LACEY
State WA
ZIP 98516
Phone 360 456-7862
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 EMMA BOBROVNIKOV

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