10D2279562 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2279562
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 3801 TAMPA RD
    OLDSMAR, FL
    ZIP 34677
  • Facility Phone: 813 854-2391
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PETER FANOUS
  • NPI Number: 1588681985
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2279562
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 3801 TAMPA RD
City OLDSMAR
State FL
ZIP 34677
Phone 813 854-2391
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/4/2025
Certificate Expiration Date 4/3/2027
Facility Type Pharmacy
Lab Director PETER FANOUS

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