52D2257105 CLIA NUMBER - WALMART PHARMACY 10-1167

Laboratory Demographics

  • CLIA Code: 52D2257105
  • Facility Name: WALMART PHARMACY 10-1167
  • Facility Address: 3500 BRUMBACK BLVD
    KENOSHA, WI
    ZIP 53144
  • Facility Phone: 262 653-1458
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LENA SOLDAYEVA
  • NPI Number: 1538186671
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257105
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1167
Street 3500 BRUMBACK BLVD
City KENOSHA
State WI
ZIP 53144
Phone 262 653-1458
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 LENA SOLDAYEVA

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