52D2261828 CLIA NUMBER - WALMART PHARMACY 10-1799

Laboratory Demographics

  • CLIA Code: 52D2261828
  • Facility Name: WALMART PHARMACY 10-1799
  • Facility Address: 2950 NEW PINERY RD
    PORTAGE, WI
    ZIP 53901
  • Facility Phone: 608 742-1670
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL SOBCZAK
  • NPI Number: 1265459317
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2261828
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1799
Street 2950 NEW PINERY RD
City PORTAGE
State WI
ZIP 53901
Phone 608 742-1670
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 DANIEL SOBCZAK

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