52D2257154 CLIA NUMBER - WALMART PHARMACY 10-910

Laboratory Demographics

  • CLIA Code: 52D2257154
  • Facility Name: WALMART PHARMACY 10-910
  • Facility Address: 201 S EDWARDS BLVD
    LAKE GENEVA, WI
    ZIP 53147
  • Facility Phone: 262 248-3421
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAI JARANSON
  • NPI Number: 1275550311
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257154
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-910
Street 201 S EDWARDS BLVD
City LAKE GENEVA
State WI
ZIP 53147
Phone 262 248-3421
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 TAI JARANSON

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