10D2179803 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179803
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 4250 PHILLIPS HWY
    JACKSONVILLE, FL
    ZIP 32207
  • Facility Phone: 904 737-7001
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAURA STEPHENS
  • NPI Number: 1609818673
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179803
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 4250 PHILLIPS HWY
City JACKSONVILLE
State FL
ZIP 32207
Phone 904 737-7001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2024
Certificate Expiration Date 3/2/2026
Facility Type Pharmacy
Lab Director LAURA STEPHENS

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