10D2179263 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2179263
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 6712 US HWY 98W
    SANTA ROSA BEACH, FL
    ZIP 32459
  • Facility Phone: 850 622-1319
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON HEFNER
  • NPI Number: 1790075760
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179263
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 6712 US HWY 98W
City SANTA ROSA BEACH
State FL
ZIP 32459
Phone 850 622-1319
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/19/2024
Certificate Expiration Date 2/18/2026
Facility Type Pharmacy
Lab Director JASON HEFNER

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