10D2278473 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2278473
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 3811 CLYDE MORRIS BLVD
    PORT ORANGE, FL
    ZIP 32129
  • Facility Phone: 386 281-6889
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL DOUGLAS
  • NPI Number: 1922456128
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2278473
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 3811 CLYDE MORRIS BLVD
City PORT ORANGE
State FL
ZIP 32129
Phone 386 281-6889
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/17/2025
Certificate Expiration Date 3/16/2027
Facility Type Pharmacy
Lab Director PAUL DOUGLAS

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