10D2179867 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

CLIA Number: 10D2179867

Facility Name: WAL-MART STORE EAST LP

Facility Address:
990 MISSOURI AVE N
LARGO, FL
ZIP 33770
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Facility Phone Number: 727 581-9922

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1851318232

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	10D2179867
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST LP
Street	990 MISSOURI AVE N
City	LARGO
State	FL
ZIP	33770
Phone	727 581-9922
CertificateType	4
CertificateEffectiveDate	3/3/2024
CertificateExpirationDate	3/2/2026
FacilityType	Waiver

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