52D2257156 CLIA NUMBER - WALMART PHARMACY 10-2509

Laboratory Demographics

CLIA Number: 52D2257156

Facility Name: WALMART PHARMACY 10-2509

Facility Address:
810 S IRISH RD
CHILTON, WI
ZIP 53014
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Facility Phone Number: 920 849-7271

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1366469439

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	52D2257156
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-2509
Street	810 S IRISH RD
City	CHILTON
State	WI
ZIP	53014
Phone	920 849-7271
CertificateType	4
CertificateEffectiveDate	3/31/2024
CertificateExpirationDate	3/30/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024