52D2257324 CLIA NUMBER - WALMART PHARMACY 10-2421

Laboratory Demographics

  • CLIA Code: 52D2257324
  • Facility Name: WALMART PHARMACY 10-2421
  • Facility Address: 2212 GLACIER DR
    ST CROIX FALLS, WI
    ZIP 54024
  • Facility Phone: 715 483-1499
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL GREMBAN
  • NPI Number: 1457378523
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2257324
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2421
Street 2212 GLACIER DR
City ST CROIX FALLS
State WI
ZIP 54024
Phone 715 483-1499
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2024
Certificate Expiration Date 4/3/2026
Facility Type Pharmacy
Lab Director MICHAEL GREMBAN

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