10D2192024 CLIA NUMBER - WALMART STORES EAST LP

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Laboratory Demographics

CLIA Number: 10D2192024

Facility Name: WALMART STORES EAST LP

Facility Address:
185 N CHARLES RICHCARD BELL BOULEVARD
DEBARY, FL
ZIP 32713
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Facility Phone Number: 386 601-0036

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1003363052

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	10D2192024
LAB Type	Pharmacy
Facility Name	WALMART STORES EAST LP
Street	185 N CHARLES RICHCARD BELL BOULEVARD
City	DEBARY
State	FL
ZIP	32713
Phone	386 601-0036
CertificateType	4
CertificateEffectiveDate	9/3/2022
CertificateExpirationDate	9/2/2024
FacilityType	Waiver

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