10D2178956 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2178956
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 4400 13TH ST
    SAINT CLOUD, FL
    ZIP 34769
  • Facility Phone: 407 957-4333
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ISMARY HERNANDEZ
  • NPI Number: 1871510248
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2178956
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 4400 13TH ST
City SAINT CLOUD
State FL
ZIP 34769
Phone 407 957-4333
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/12/2024
Certificate Expiration Date 2/11/2026
Facility Type Pharmacy
Lab Director ISMARY HERNANDEZ

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