10D2189415 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2189415
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 1580 BRANAN FIELD RD
    MIDDLEBURG, FL
    ZIP 32068
  • Facility Phone: 904 214-9115
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LARRY COY
  • NPI Number: 1205926276
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2189415
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 1580 BRANAN FIELD RD
City MIDDLEBURG
State FL
ZIP 32068
Phone 904 214-9115
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 LARRY COY

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