10D2286164 CLIA NUMBER - WAL-MART STORES EAST, LP

Laboratory Demographics

  • CLIA Code: 10D2286164
  • Facility Name: WAL-MART STORES EAST, LP
  • Facility Address: 4928 STATE RD 674
    WIMAUMA, FL
    ZIP 33598
  • Facility Phone: 813 633-1463
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DHARMESH RANA
  • NPI Number: 1043237415
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2286164
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP
Street 4928 STATE RD 674
City WIMAUMA
State FL
ZIP 33598
Phone 813 633-1463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/25/2025
Certificate Expiration Date 7/24/2027
Facility Type Pharmacy
Lab Director DHARMESH RANA

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