51D2127599 CLIA NUMBER - WALMART PHARMACY 10-1714

Laboratory Demographics

  • CLIA Code: 51D2127599
  • Facility Name: WALMART PHARMACY 10-1714
  • Facility Address: 32 TYGART MALL LOOP
    FAIRMONT, WV
    ZIP 26554
  • Facility Phone: 304 366-9115
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK A. BENEDETTI
  • NPI Number: 1992722029
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2127599
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1714
Street 32 TYGART MALL LOOP
City FAIRMONT
State WV
ZIP 26554
Phone 304 366-9115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/15/2025
Certificate Expiration Date 3/14/2027
Facility Type Pharmacy
Lab Director MARK A. BENEDETTI

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