10D2192161 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2192161
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 3501 S FLORIDA AVE
    LAKELAND, FL
    ZIP 33803
  • Facility Phone: 863 644-0671
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOCELYN DIAZ
  • NPI Number: 1235156449
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2192161
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 3501 S FLORIDA AVE
City LAKELAND
State FL
ZIP 33803
Phone 863 644-0671
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/5/2024
Certificate Expiration Date 9/4/2026
Facility Type Pharmacy
Lab Director JOCELYN DIAZ

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