10D2208050 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2208050
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 4600 MOBILE HWY STE 122
    PENSACOLA, FL
    ZIP 32506
  • Facility Phone: 850 455-3620
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MARYANN NEAMATALLA
  • NPI Number: 1861419244
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2208050
LAB Type Physician Office
Facility Name WAL-MART STORES EAST, LP
Street 4600 MOBILE HWY STE 122
City PENSACOLA
State FL
ZIP 32506
Phone 850 455-3620
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2025
Certificate Expiration Date 1/3/2027
Facility Type Physician Office
Lab Director MARYANN NEAMATALLA

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