53D2154306 CLIA NUMBER - WALMART PHARMACY #10-1461

Laboratory Demographics

  • CLIA Code: 53D2154306
  • Facility Name: WALMART PHARMACY #10-1461
  • Facility Address: 201 GATEWAY BLVD
    ROCK SPRINGS, WY
    ZIP 82901
  • Facility Phone: 307 362-1957
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAFE ELLERBECK
  • NPI Number: 1649350133
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 53D2154306
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1461
Street 201 GATEWAY BLVD
City ROCK SPRINGS
State WY
ZIP 82901
Phone 307 362-1957
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Pharmacy
Lab Director LAFE ELLERBECK

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