10D2178902 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2178902
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 101 N CONGRESS AVE ATTN: WALMART PHARMACY 10-3348
    LAKE PARK, FL
    ZIP 33403
  • Facility Phone: 561 842-8966
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JERRIN SAMUEL
  • NPI Number: 1114035508
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2178902
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 101 N CONGRESS AVE ATTN: WALMART PHARMACY 10-3348
City LAKE PARK
State FL
ZIP 33403
Phone 561 842-8966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Pharmacy
Lab Director JERRIN SAMUEL

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