10D2180394 CLIA NUMBER - WAL-MART STORE EAST LP

Laboratory Demographics

CLIA Number: 10D2180394

Facility Name: WAL-MART STORE EAST LP

Facility Address:
6177 S JOG RD
LAKE WORTH, FL
ZIP 33467
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Facility Phone Number: 561 964-0607

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1972749521

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	10D2180394
LAB Type	Pharmacy
Facility Name	WAL-MART STORE EAST LP
Street	6177 S JOG RD
City	LAKE WORTH
State	FL
ZIP	33467
Phone	561 964-0607
CertificateType	4
CertificateEffectiveDate	3/12/2024
CertificateExpirationDate	3/11/2026
FacilityType	Waiver

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