10D2179367 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

CLIA Number: 10D2179367

Facility Name: WAL-MART STORES EAST, LP

Facility Address:
4105 S STATE ROAD 7 ATTN:WALMART PHARMACY 10-6967
LAKE WORTH, FL
ZIP 33449
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Facility Phone Number: 561 207-3471

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1922491158

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	10D2179367
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST, LP
Street	4105 S STATE ROAD 7 ATTN:WALMART PHARMACY 10-6967
City	LAKE WORTH
State	FL
ZIP	33449
Phone	561 207-3471
CertificateType	4
CertificateEffectiveDate	2/21/2024
CertificateExpirationDate	2/20/2026
FacilityType	Waiver

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