10D2191368 CLIA NUMBER - WAL-MART STORES EAST LP

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Laboratory Demographics

CLIA Number: 10D2191368

Facility Name: WAL-MART STORES EAST LP

Facility Address:
19910 BRUCE B DOWNS BLVD
TAMPA, FL
ZIP 33647
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Facility Phone Number: 813 907-7587

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215954615

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	10D2191368
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST LP
Street	19910 BRUCE B DOWNS BLVD
City	TAMPA
State	FL
ZIP	33647
Phone	813 907-7587
CertificateType	4
CertificateEffectiveDate	8/26/2022
CertificateExpirationDate	8/25/2024
FacilityType	Waiver

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