10D2179006 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179006
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 3950 N WICKHAM RD ATTN WALMART PHARMACY 10-5365
    MELBOURNE, FL
    ZIP 32935
  • Facility Phone: 321 254-4170
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: QUAN HADDOCK
  • NPI Number: 1245259225
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179006
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 3950 N WICKHAM RD ATTN WALMART PHARMACY 10-5365
City MELBOURNE
State FL
ZIP 32935
Phone 321 254-4170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2024
Certificate Expiration Date 2/12/2026
Facility Type Pharmacy
Lab Director QUAN HADDOCK

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