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52D2258439 CLIA NUMBER - WALMART PHARMACY 10-1635

Laboratory Demographics

CLIA Number: 52D2258439

Facility Name: WALMART PHARMACY 10-1635

Facility Address:
2000 S WEST AVE
WAUKESHA, WI
ZIP 53189
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Facility Phone Number: 262 521-9204

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1275550329

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 52D2258439
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1635
Street 2000 S WEST AVE
City WAUKESHA
State WI
ZIP 53189
Phone 262 521-9204
CertificateType 4
CertificateEffectiveDate 4/21/2024
CertificateExpirationDate 4/20/2026
FacilityType Waiver

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