10D2191138 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2191138
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 2355 US HIGHWAY 1 S
    ST AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 794-4134
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAULINE CELESTIAL
  • NPI Number: 1407873714
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2191138
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 2355 US HIGHWAY 1 S
City ST AUGUSTINE
State FL
ZIP 32086
Phone 904 794-4134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2024
Certificate Expiration Date 8/23/2026
Facility Type Pharmacy
Lab Director PAULINE CELESTIAL

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