53D2154652 CLIA NUMBER - WALMART PHARMACY #10-4653

Laboratory Demographics

  • CLIA Code: 53D2154652
  • Facility Name: WALMART PHARMACY #10-4653
  • Facility Address: 580 LIVINGSTON AVENUE
    CHEYENNE, WY
    ZIP 82007
  • Facility Phone: 307 823-6810
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CODY PHILLIPS
  • NPI Number: 1255718953
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 53D2154652
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4653
Street 580 LIVINGSTON AVENUE
City CHEYENNE
State WY
ZIP 82007
Phone 307 823-6810
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Pharmacy
Lab Director CODY PHILLIPS

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