50D2177770 CLIA NUMBER - WALMART PHARMACY 10-5461

Laboratory Demographics

  • CLIA Code: 50D2177770
  • Facility Name: WALMART PHARMACY 10-5461
  • Facility Address: 14505 NE FOURTH PLAIN BLVD
    VANCOUVER, WA
    ZIP 98682
  • Facility Phone: 360 258-2653
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASEEL BATROUKH
  • NPI Number: 1578945952
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 50D2177770
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5461
Street 14505 NE FOURTH PLAIN BLVD
City VANCOUVER
State WA
ZIP 98682
Phone 360 258-2653
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/17/2020
Certificate Expiration Date 4/4/2028
Facility Type Pharmacy
Lab Director ASEEL BATROUKH

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