03D2120919 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1370

Laboratory Demographics

  • CLIA Code: 03D2120919
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1370
  • Facility Address: 2840 HIGHWAY 95
    BULLHEAD CITY, AZ
    ZIP 86442
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN MOLLOY
  • NPI Number: 1255358479
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2120919
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1370
Street 2840 HIGHWAY 95
City BULLHEAD CITY
State AZ
ZIP 86442
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 KEVIN MOLLOY

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