52D2258634 CLIA NUMBER - WALMART PHARMACY 10-1366

Laboratory Demographics

  • CLIA Code: 52D2258634
  • Facility Name: WALMART PHARMACY 10-1366
  • Facility Address: 505 S PINE RIDGE AVE
    MERRILL, WI
    ZIP 54452
  • Facility Phone: 715 536-5530
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBBY BASTLE
  • NPI Number: 1558388603
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2258634
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1366
Street 505 S PINE RIDGE AVE
City MERRILL
State WI
ZIP 54452
Phone 715 536-5530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/25/2024
Certificate Expiration Date 4/24/2026
Facility Type Pharmacy
Lab Director ROBBY BASTLE

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