10D2190785 CLIA NUMBER - WAL-MART STORES EAST, LP

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Laboratory Demographics

CLIA Number: 10D2190785

Facility Name: WAL-MART STORES EAST, LP

Facility Address:
12800 PINES BLVD
PEMBROKE PINES, FL
ZIP 33027
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Facility Phone Number: 954 378-1367

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1548547052

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	10D2190785
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST, LP
Street	12800 PINES BLVD
City	PEMBROKE PINES
State	FL
ZIP	33027
Phone	954 378-1367
CertificateType	4
CertificateEffectiveDate	8/19/2022
CertificateExpirationDate	8/18/2024
FacilityType	Waiver

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