10D2180114 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

CLIA Number: 10D2180114

Facility Name: WAL-MART STORE EAST LP

Facility Address:
4320 W GANDY BLVD
TAMPA, FL
ZIP 33611
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Facility Phone Number: 813 839-3175

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1497062442

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	10D2180114
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST LP
Street	4320 W GANDY BLVD
City	TAMPA
State	FL
ZIP	33611
Phone	813 839-3175
CertificateType	4
CertificateEffectiveDate	3/6/2024
CertificateExpirationDate	3/5/2026
FacilityType	Waiver

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