10D2276391 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

CLIA Number: 10D2276391

Facility Name: WAL-MART STORES EAST LP

Facility Address:
2911 53RD AVE E WALMART PHARMACY #10-528
BRADEN RIVER, FL
ZIP 34203
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Facility Phone Number: 941 753-6764

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1871510180

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	10D2276391
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST LP
Street	2911 53RD AVE E WALMART PHARMACY #10-528
City	BRADEN RIVER
State	FL
ZIP	34203
Phone	941 753-6764
CertificateType	4
CertificateEffectiveDate	2/8/2023
CertificateExpirationDate	2/7/2025
FacilityType	Waiver

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