10D2189471 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2189471
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 3767 GULF BREEZ PKWY
    GULF BREEZE, FL
    ZIP 32563
  • Facility Phone: 850 934-3178
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MALLORY THORSEN
  • NPI Number: 1760409155
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2189471
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 3767 GULF BREEZ PKWY
City GULF BREEZE
State FL
ZIP 32563
Phone 850 934-3178
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Pharmacy
Lab Director MALLORY THORSEN

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