10D2188613 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

CLIA Number: 10D2188613

Facility Name: WAL-MART STORES EAST, LP

Facility Address:
4770 COLONIAL BLVD
FORT MYERS, FL
ZIP 33966
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Facility Phone Number: 239 274-2927

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1265451249

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	10D2188613
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST, LP
Street	4770 COLONIAL BLVD
City	FORT MYERS
State	FL
ZIP	33966
Phone	239 274-2927
CertificateType	4
CertificateEffectiveDate	7/20/2022
CertificateExpirationDate	7/19/2024
FacilityType	Waiver

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