10D2180042 CLIA NUMBER - WAL-MART STORE EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2180042
  • Facility Name: WAL-MART STORE EAST, LP
  • Facility Address: 1300 JOHN SIMS PKWY E
    NICEVILLE, FL
    ZIP 32578
  • Facility Phone: 850 678-9209
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSICA SMITH
  • NPI Number: 1972803674
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180042
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST, LP
Street 1300 JOHN SIMS PKWY E
City NICEVILLE
State FL
ZIP 32578
Phone 850 678-9209
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/5/2024
Certificate Expiration Date 3/4/2026
Facility Type Pharmacy
Lab Director JESSICA SMITH

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