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

Laboratory Demographics

CLIA Number: 10D2178902

Facility Name: WAL-MART STORES EAST, LP

Facility Address:
101 N CONGRESS AVE ATTN: WALMART PHARMACY 10-3348
LAKE PARK, FL
ZIP 33403
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Facility Phone Number: 561 842-8966

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1114035508

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	2/11/2024
CertificateExpirationDate	2/10/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024