52D2261824 CLIA NUMBER - WALMART PHARMACY 10-5127

Laboratory Demographics

  • CLIA Code: 52D2261824
  • Facility Name: WALMART PHARMACY 10-5127
  • Facility Address: 4622 MORMON COULEE RD
    BARRE MILLS, WI
    ZIP 54601
  • Facility Phone: 920 336-7168
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT HORN
  • NPI Number: 1609893775
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2261824
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5127
Street 4622 MORMON COULEE RD
City BARRE MILLS
State WI
ZIP 54601
Phone 920 336-7168
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/6/2024
Certificate Expiration Date 6/5/2026
Facility Type Pharmacy
Lab Director SCOTT HORN

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