10D2179674 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179674
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 10550 OLD ST AUGUSTINE RD
    JACKSONVILLE, FL
    ZIP 32257
  • Facility Phone: 904 380-8274
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DUSTIN MAUPIN
  • NPI Number: 1316289283
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179674
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 10550 OLD ST AUGUSTINE RD
City JACKSONVILLE
State FL
ZIP 32257
Phone 904 380-8274
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/29/2024
Certificate Expiration Date 2/27/2026
Facility Type Pharmacy
Lab Director DUSTIN MAUPIN

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