10D2178689 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2178689
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 1850 SW GATLIN BLVD ATTN WALMART PHARMACY 10-4260
    PORT SAINT LUCIE, FL
    ZIP 34953
  • Facility Phone: 772 336-8268
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL STATLER
  • NPI Number: 1720112832
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2178689
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 1850 SW GATLIN BLVD ATTN WALMART PHARMACY 10-4260
City PORT SAINT LUCIE
State FL
ZIP 34953
Phone 772 336-8268
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Pharmacy
Lab Director SAMUEL STATLER

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