10D2180151 CLIA NUMBER - WAL-MART STORE EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2180151
  • Facility Name: WAL-MART STORE EAST, LP
  • Facility Address: 2001 US HIGHWAY #1
    SEBASTIAN, FL
    ZIP 32958
  • Facility Phone: 772 589-7556
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICARDO S. BOURGOIN
  • NPI Number: 1053338426
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180151
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST, LP
Street 2001 US HIGHWAY #1
City SEBASTIAN
State FL
ZIP 32958
Phone 772 589-7556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2024
Certificate Expiration Date 3/8/2026
Facility Type Pharmacy
Lab Director RICARDO S. BOURGOIN

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