52D2257091 CLIA NUMBER - WALMART PHARMACY 10-5669

Laboratory Demographics

  • CLIA Code: 52D2257091
  • Facility Name: WALMART PHARMACY 10-5669
  • Facility Address: 4140 W GREENFIELD AVE
    WEST MILWAUKEE, WI
    ZIP 53215
  • Facility Phone: 414 978-9019
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN RYDMAN
  • NPI Number: 1083631154
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257091
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5669
Street 4140 W GREENFIELD AVE
City WEST MILWAUKEE
State WI
ZIP 53215
Phone 414 978-9019
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2024
Certificate Expiration Date 3/30/2026
Facility Type Pharmacy
Lab Director JOHN RYDMAN

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