10D2191188 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2191188
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 902 SW SAINT LUCIE WEST BLVD
    PORT SAINT LUCIE, FL
    ZIP 34986
  • Facility Phone: 772 446-8743
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFREY C. ASHLINE
  • NPI Number: 1861859456
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2191188
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 902 SW SAINT LUCIE WEST BLVD
City PORT SAINT LUCIE
State FL
ZIP 34986
Phone 772 446-8743
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2024
Certificate Expiration Date 8/24/2026
Facility Type Pharmacy
Lab Director JEFFREY C. ASHLINE

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