03D2145442 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1369

Laboratory Demographics

  • CLIA Code: 03D2145442
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1369
  • Facility Address: 300 N BEELINE HWY
    PAYSON, AZ
    ZIP 85541
  • Facility Phone: 928 474-0034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK I. WESTBERG
  • NPI Number: 1255358461
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2145442
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1369
Street 300 N BEELINE HWY
City PAYSON
State AZ
ZIP 85541
Phone 928 474-0034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2024
Certificate Expiration Date 3/6/2026
Facility Type Pharmacy
Lab Director MARK I. WESTBERG

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