10D2283423 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2283423
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 445 STATE ROAD 13
    FRUIT COVE, FL
    ZIP 32259
  • Facility Phone: 904 417-9088
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER MARCOUX
  • NPI Number: 1467890731
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2283423
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 445 STATE ROAD 13
City FRUIT COVE
State FL
ZIP 32259
Phone 904 417-9088
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/7/2025
Certificate Expiration Date 6/6/2027
Facility Type Pharmacy
Lab Director JENNIFER MARCOUX

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