10D2189383 CLIA NUMBER - WAL-MART STORES EAST, LP #10-0929

Laboratory Demographics

  • CLIA Code: 10D2189383
  • Facility Name: WAL-MART STORES EAST, LP #10-0929
  • Facility Address: 10855 SO US HWY #1
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Facility Phone: 772 335-1557
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNA JAMES
  • NPI Number: 1689691891
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2189383
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP #10-0929
Street 10855 SO US HWY #1
City PORT SAINT LUCIE
State FL
ZIP 34952
Phone 772 335-1557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Pharmacy
Lab Director JENNA JAMES

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