10D2178974 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2178974
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 1675 NW SAINT LUCIE WEST BLVD ATTN: WALMART PHARMACY 10-3527
    PORT SAINT LUCIE, FL
    ZIP 34986
  • Facility Phone: 772 873-1616
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON WILDERMUTH
  • NPI Number: 1427487396
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2178974
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 1675 NW SAINT LUCIE WEST BLVD ATTN: WALMART PHARMACY 10-3527
City PORT SAINT LUCIE
State FL
ZIP 34986
Phone 772 873-1616
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 BRANDON WILDERMUTH

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