03D2120928 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1474

Laboratory Demographics

  • CLIA Code: 03D2120928
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1474
  • Facility Address: 2900 S PACIFIC AVE
    YUMA, AZ
    ZIP 85365
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACK LEE
  • NPI Number: 1609893817
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2120928
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1474
Street 2900 S PACIFIC AVE
City YUMA
State AZ
ZIP 85365
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 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Pharmacy
Lab Director JACK LEE

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