10D2213280 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2213280
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 1590 DUNLAWTON AVE
    PORT ORANGE, FL
    ZIP 32127
  • Facility Phone: 386 761-0191
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARIAM YOUNAN
  • NPI Number: 1033136411
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2213280
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 1590 DUNLAWTON AVE
City PORT ORANGE
State FL
ZIP 32127
Phone 386 761-0191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/11/2025
Certificate Expiration Date 2/10/2027
Facility Type Pharmacy
Lab Director MARIAM YOUNAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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