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01D2158959 CLIA NUMBER - WALMART PHARMACY 10-691

Laboratory Demographics

CLIA Number: 01D2158959

Facility Name: WALMART PHARMACY 10-691

Facility Address:
2001 GLENN BLVD SW
FORT PAYNE, AL
ZIP 35968
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Facility Phone Number: 256 997-1194

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1720006158

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 01D2158959
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-691
Street 2001 GLENN BLVD SW
City FORT PAYNE
State AL
ZIP 35968
Phone 256 997-1194
CertificateType 4
CertificateEffectiveDate 12/11/2022
CertificateExpirationDate 12/10/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024