52D2258157 CLIA NUMBER - WALMART PHARMACY 10-2545

Laboratory Demographics

  • CLIA Code: 52D2258157
  • Facility Name: WALMART PHARMACY 10-2545
  • Facility Address: 2900 ROOSEVELT RD
    MARINETTE, WI
    ZIP 54143
  • Facility Phone: 608 362-7774
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER NICKEL
  • NPI Number: 1992722060
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2258157
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2545
Street 2900 ROOSEVELT RD
City MARINETTE
State WI
ZIP 54143
Phone 608 362-7774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Pharmacy
Lab Director TYLER NICKEL

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