53D2154233 CLIA NUMBER - WALMART PHARMACY #10-1412

Laboratory Demographics

  • CLIA Code: 53D2154233
  • Facility Name: WALMART PHARMACY #10-1412
  • Facility Address: 4308 E GRAND AVE
    LARAMIE, WY
    ZIP 82070
  • Facility Phone: 307 745-6100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JADE ENEVOLDSEN
  • NPI Number: 1235219858
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 53D2154233
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1412
Street 4308 E GRAND AVE
City LARAMIE
State WY
ZIP 82070
Phone 307 745-6100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Pharmacy
Lab Director JADE ENEVOLDSEN

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