10D2192036 CLIA NUMBER - WALMART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2192036
  • Facility Name: WALMART STORES EAST LP
  • Facility Address: 1521 W GRANADA BLVD
    ORMOND BEACH, FL
    ZIP 32174
  • Facility Phone: 386 672-2030
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SYLMARIE BONET MIRANDA
  • NPI Number: 1225055536
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2192036
LAB Type Pharmacy
Facility Name WALMART STORES EAST LP
Street 1521 W GRANADA BLVD
City ORMOND BEACH
State FL
ZIP 32174
Phone 386 672-2030
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/3/2024
Certificate Expiration Date 9/2/2026
Facility Type Pharmacy
Lab Director SYLMARIE BONET MIRANDA

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