10D2180021 CLIA NUMBER - WAL-MART STORE EAST, LP

Laboratory Demographics

CLIA Number: 10D2180021

Facility Name: WAL-MART STORE EAST, LP

Facility Address:
401 E SHERIDAN ST
DANIA BEACH, FL
ZIP 33004
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Facility Phone Number: 954 988-5210

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457709651

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	10D2180021
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST, LP
Street	401 E SHERIDAN ST
City	DANIA BEACH
State	FL
ZIP	33004
Phone	954 988-5210
CertificateType	4
CertificateEffectiveDate	3/5/2024
CertificateExpirationDate	3/4/2026
FacilityType	Waiver

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