10D2180298 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2180298
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 505 SW PINE ISLAND RD
    CAPE CORAL, FL
    ZIP 33991
  • Facility Phone: 239 458-8045
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON TIRB
  • NPI Number: 1205044187
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180298
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 505 SW PINE ISLAND RD
City CAPE CORAL
State FL
ZIP 33991
Phone 239 458-8045
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/11/2024
Certificate Expiration Date 3/10/2026
Facility Type Pharmacy
Lab Director JASON TIRB

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