10D2189784 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2189784
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 1699 N WOODLAND BLVD ATTN:WALMART PHARMACY 10-860
    DELAND, FL
    ZIP 32720
  • Facility Phone: 386 734-1311
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISANDRA PLOG
  • NPI Number: 1316964521
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2189784
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 1699 N WOODLAND BLVD ATTN:WALMART PHARMACY 10-860
City DELAND
State FL
ZIP 32720
Phone 386 734-1311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Pharmacy
Lab Director MELISANDRA PLOG

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