10D2180391 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

  • CLIA Code: 10D2180391
  • Facility Name: WAL-MART STORE EAST LP
  • Facility Address: 375 KINGS HWY
    PORT CHARLOTTE, FL
    ZIP 33983
  • Facility Phone: 941 625-5008
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELE L. FOWLER
  • NPI Number: 1023126414
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2180391
LAB Type Pharmacy
Facility Name WAL-MART STORE EAST LP
Street 375 KINGS HWY
City PORT CHARLOTTE
State FL
ZIP 33983
Phone 941 625-5008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Pharmacy
Lab Director MICHELE L. FOWLER

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