10D2179711 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179711
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 2600 SW 19TH AVE RD
    OCALA, FL
    ZIP 34471
  • Facility Phone: 352 237-7103
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LARRY BANKOLE
  • NPI Number: 1861419178
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179711
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 2600 SW 19TH AVE RD
City OCALA
State FL
ZIP 34471
Phone 352 237-7103
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 LARRY BANKOLE

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