10D2191185 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2191185
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 2855 N OLD LAKE WILSON ROAD
    KISSIMMEE, FL
    ZIP 34747
  • Facility Phone: 407 606-0111
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PETER Q. VU
  • NPI Number: 1528584083
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2191185
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 2855 N OLD LAKE WILSON ROAD
City KISSIMMEE
State FL
ZIP 34747
Phone 407 606-0111
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 PETER Q. VU

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