52D2257131 CLIA NUMBER - WALMART PHARMACY 10-1828

Laboratory Demographics

  • CLIA Code: 52D2257131
  • Facility Name: WALMART PHARMACY 10-1828
  • Facility Address: 250 CROSSOVER DR
    PLOVER, WI
    ZIP 54467
  • Facility Phone: 715 345-7870
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACOB SUTHERLAND
  • NPI Number: 1083631139
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257131
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1828
Street 250 CROSSOVER DR
City PLOVER
State WI
ZIP 54467
Phone 715 345-7870
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 JACOB SUTHERLAND

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