52D2257205 CLIA NUMBER - WALMART PHARMACY 10-1471

Laboratory Demographics

  • CLIA Code: 52D2257205
  • Facility Name: WALMART PHARMACY 10-1471
  • Facility Address: 1717 N SHAWANO ST
    NEW LONDON, WI
    ZIP 54961
  • Facility Phone: 920 982-7906
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GABE BARNES
  • NPI Number: 1720005879
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257205
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1471
Street 1717 N SHAWANO ST
City NEW LONDON
State WI
ZIP 54961
Phone 920 982-7906
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2024
Certificate Expiration Date 3/31/2026
Facility Type Pharmacy
Lab Director GABE BARNES

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