52D2257210 CLIA NUMBER - WALMART PHARMACY 10-5463

Laboratory Demographics

CLIA Number: 52D2257210

Facility Name: WALMART PHARMACY 10-5463

Facility Address:
1220 THEIL ST
HARTFORD, WI
ZIP 53027
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Facility Phone Number: 262 794-2734

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477938025

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	52D2257210
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-5463
Street	1220 THEIL ST
City	HARTFORD
State	WI
ZIP	53027
Phone	262 794-2734
CertificateType	4
CertificateEffectiveDate	4/1/2024
CertificateExpirationDate	3/31/2026
FacilityType	Waiver

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