52D2258866 CLIA NUMBER - WALMART PHARMACY 10-1277

Laboratory Demographics

  • CLIA Code: 52D2258866
  • Facility Name: WALMART PHARMACY 10-1277
  • Facility Address: 611 STATE HIGHWAY 54
    BLACK RIVER FALLS, WI
    ZIP 54615
  • Facility Phone: 715 284-9115
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENORA J. MCBRIDE
  • NPI Number: 1417975111
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2258866
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1277
Street 611 STATE HIGHWAY 54
City BLACK RIVER FALLS
State WI
ZIP 54615
Phone 715 284-9115
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Pharmacy
Lab Director BENORA J. MCBRIDE

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