10D2180122 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2180122
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 13300 CORTEZ BLVD
    BROOKSVILLE, FL
    ZIP 34613
  • Facility Phone: 352 596-0797
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY TOUT
  • NPI Number: 1306863774
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180122
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 13300 CORTEZ BLVD
City BROOKSVILLE
State FL
ZIP 34613
Phone 352 596-0797
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 TIMOTHY TOUT

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