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52D2258630 CLIA NUMBER - WALMART PHARMACY 10-1453

Laboratory Demographics

CLIA Number: 52D2258630

Facility Name: WALMART PHARMACY 10-1453

Facility Address:
2240 W MASON ST
GREEN BAY, WI
ZIP 54303
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Facility Phone Number: 920 499-2330

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1902823057

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 52D2258630
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1453
Street 2240 W MASON ST
City GREEN BAY
State WI
ZIP 54303
Phone 920 499-2330
CertificateType 4
CertificateEffectiveDate 4/25/2024
CertificateExpirationDate 4/24/2026
FacilityType Waiver

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