10D2179880 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179880
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 8745 STATE RD 54
    NEW PORT RICHEY, FL
    ZIP 34655
  • Facility Phone: 727 376-5545
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SANDRA KEROLES
  • NPI Number: 1154348522
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179880
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 8745 STATE RD 54
City NEW PORT RICHEY
State FL
ZIP 34655
Phone 727 376-5545
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 SANDRA KEROLES

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