10D2179964 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2179964
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 9550 BAYMEADOWS RD
    JACKSONVILLE, FL
    ZIP 32256
  • Facility Phone: 904 431-6356
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID M. HANANIA
  • NPI Number: 1356842512
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2179964
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 9550 BAYMEADOWS RD
City JACKSONVILLE
State FL
ZIP 32256
Phone 904 431-6356
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2024
Certificate Expiration Date 3/3/2026
Facility Type Pharmacy
Lab Director DAVID M. HANANIA

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