10D2179739 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

CLIA Number: 10D2179739

Facility Name: WAL-MART STORE EAST LP

Facility Address:
14500 US HWY 301 S
STARKE, FL
ZIP 32091
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Facility Phone Number: 904 964-3290

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1508883984

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	10D2179739
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST LP
Street	14500 US HWY 301 S
City	STARKE
State	FL
ZIP	32091
Phone	904 964-3290
CertificateType	4
CertificateEffectiveDate	3/2/2024
CertificateExpirationDate	3/1/2026
FacilityType	Waiver

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