10D2190711 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2190711
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 11012 NO. WILLIAMS ST
    DUNNELLON, FL
    ZIP 34432
  • Facility Phone: 352 489-4241
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY MANCINI
  • NPI Number: 1306863519
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2190711
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 11012 NO. WILLIAMS ST
City DUNNELLON
State FL
ZIP 34432
Phone 352 489-4241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2024
Certificate Expiration Date 8/17/2026
Facility Type Pharmacy
Lab Director MARY MANCINI

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