10D2190973 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2190973
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 4444 W VINE ST
    KISSIMMEE, FL
    ZIP 34746
  • Facility Phone: 407 397-1002
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHUONG PHAM
  • NPI Number: 1043239023
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2190973
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 4444 W VINE ST
City KISSIMMEE
State FL
ZIP 34746
Phone 407 397-1002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Pharmacy
Lab Director PHUONG PHAM

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