10D2190648 CLIA NUMBER - WAL-MART STORES EAST, LP

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Laboratory Demographics

CLIA Number: 10D2190648

Facility Name: WAL-MART STORES EAST, LP

Facility Address:
2951 S BLUE ANGEL PKWY WAL-MART PHARMACY 10-3484
PENSACOLA, FL
ZIP 32506
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Facility Phone Number: 850 458-5606

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093734071

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	10D2190648
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST, LP
Street	2951 S BLUE ANGEL PKWY WAL-MART PHARMACY 10-3484
City	PENSACOLA
State	FL
ZIP	32506
Phone	850 458-5606
CertificateType	4
CertificateEffectiveDate	8/18/2022
CertificateExpirationDate	8/17/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024