10D2207029 CLIA NUMBER - WAL-MART STORES EAST, LP WALMART PHARMACY 10-1082

Laboratory Demographics

  • CLIA Code: 10D2207029
  • Facility Name: WAL-MART STORES EAST, LP WALMART PHARMACY 10-1082
  • Facility Address: 10991 SAN JOSE BLVD STE 1
    JACKSONVILLE, FL
    ZIP 32223
  • Facility Phone: 904 260-4402
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JIE SONG
  • NPI Number: 1598856882
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 10D2207029
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP WALMART PHARMACY 10-1082
Street 10991 SAN JOSE BLVD STE 1
City JACKSONVILLE
State FL
ZIP 32223
Phone 904 260-4402
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2024
Certificate Expiration Date 12/22/2026
Facility Type Pharmacy
Lab Director JIE SONG

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