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

Laboratory Demographics

  • CLIA Code: 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
  • Facility Phone: 561 207-3471
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: INEZ CICCIO
  • NPI Number: 1922491158
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Pharmacy
Lab Director INEZ CICCIO

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