51D2127623 CLIA NUMBER - WALMART PHARMACY 10-1360

Laboratory Demographics

  • CLIA Code: 51D2127623
  • Facility Name: WALMART PHARMACY 10-1360
  • Facility Address: 204 TOWN CENTER RD
    FAYETTEVILLE, WV
    ZIP 25840
  • Facility Phone: 304 574-1279
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW A. WRISTON
  • NPI Number: 1811914948
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2127623
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1360
Street 204 TOWN CENTER RD
City FAYETTEVILLE
State WV
ZIP 25840
Phone 304 574-1279
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Pharmacy
Lab Director MATTHEW A. WRISTON

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