03D2120918 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3604

Laboratory Demographics

  • CLIA Code: 03D2120918
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3604
  • Facility Address: 14200 W INDIAN SCHOOL RD
    GOODYEAR, AZ
    ZIP 85395
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LONG NGUYEN
  • NPI Number: 1194882654
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 03D2120918
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3604
Street 14200 W INDIAN SCHOOL RD
City GOODYEAR
State AZ
ZIP 85395
Phone 479 258-7034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/26/2024
Certificate Expiration Date 10/25/2026
Facility Type Pharmacy
Lab Director LONG NGUYEN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 6/4/2025