10D2191441 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2191441
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 5100 OKEECHOBEE RD
    FORT PIERCE, FL
    ZIP 34947
  • Facility Phone: (772) 465-6601
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TASHA HALL
  • NPI Number: 1417974882
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2191441
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 5100 OKEECHOBEE RD
City FORT PIERCE
State FL
ZIP 34947
Phone 7724656601
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/27/2024
Certificate Expiration Date 8/26/2026
Facility Type Pharmacy
Lab Director TASHA HALL

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This page was last updated on: 5/15/2026