10D2180122 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

CLIA Number: 10D2180122

Facility Name: WAL-MART STORE EAST LP

Facility Address:
13300 CORTEZ BLVD
BROOKSVILLE, FL
ZIP 34613
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Facility Phone Number: 352 596-0797

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306863774

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	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
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