10D2180153 CLIA NUMBER - WAL-MART STORE EAST, LP

Laboratory Demographics

CLIA Number: 10D2180153

Facility Name: WAL-MART STORE EAST, LP

Facility Address:
200 S STATE ROAD 434
ALTAMONTE SPRINGS, FL
ZIP 32714
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Facility Phone Number: 407 774-6255

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1144247529

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	10D2180153
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST, LP
Street	200 S STATE ROAD 434
City	ALTAMONTE SPRINGS
State	FL
ZIP	32714
Phone	407 774-6255
CertificateType	4
CertificateEffectiveDate	3/9/2024
CertificateExpirationDate	3/8/2026
FacilityType	Waiver

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