10D2206902 CLIA NUMBER - WAL-MART STORES EAST LP

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Laboratory Demographics

CLIA Number: 10D2206902

Facility Name: WAL-MART STORES EAST LP

Facility Address:
1800 NE 12TH AVENUE
GAINESVILLE, FL
ZIP 32641
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Facility Phone Number: 352 372-3191

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1215119946

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	10D2206902
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST LP
Street	1800 NE 12TH AVENUE
City	GAINESVILLE
State	FL
ZIP	32641
Phone	352 372-3191
CertificateType	4
CertificateEffectiveDate	12/23/2022
CertificateExpirationDate	12/22/2024
FacilityType	Waiver

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