10D2191867 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2191867
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 8500 NORTH WICKHAM RD
    MELBOURNE, FL
    ZIP 32940
  • Facility Phone: 321 242-6778
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CRAIG BRUBAKER
  • NPI Number: 1750308151
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2191867
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 8500 NORTH WICKHAM RD
City MELBOURNE
State FL
ZIP 32940
Phone 321 242-6778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/2/2024
Certificate Expiration Date 9/1/2026
Facility Type Pharmacy
Lab Director CRAIG BRUBAKER

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