10D2190208 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2190208
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 1500 E MERRITT ISLAND CSWY
    MERRITT ISLAND, FL
    ZIP 32952
  • Facility Phone: 321 452-4340
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW WONG
  • NPI Number: 1417974627
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2190208
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 1500 E MERRITT ISLAND CSWY
City MERRITT ISLAND
State FL
ZIP 32952
Phone 321 452-4340
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Pharmacy
Lab Director ANDREW WONG

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