10D2180105 CLIA NUMBER - WAL-MART STORE EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2180105
  • Facility Name: WAL-MART STORE EAST, LP
  • Facility Address: 1001 E EAU GALLIE BLVD
    MELBOURNE, FL
    ZIP 32937
  • Facility Phone: 321 773-0663
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THEA YATES
  • NPI Number: 1497772602
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180105
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST, LP
Street 1001 E EAU GALLIE BLVD
City MELBOURNE
State FL
ZIP 32937
Phone 321 773-0663
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2024
Certificate Expiration Date 3/5/2026
Facility Type Pharmacy
Lab Director THEA YATES

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