10D2286625 CLIA NUMBER - WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 10D2286625
  • Facility Name: WAL-MART STORES EAST LP
  • Facility Address: 2767 W US HIGHWAY 90
    LAKE CITY, FL
    ZIP 32055
  • Facility Phone: (386) 755-0463
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHNEICELA V. PERRY
  • NPI Number: 1215954524
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2286625
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST LP
Street 2767 W US HIGHWAY 90
City LAKE CITY
State FL
ZIP 32055
Phone 3867550463
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/1/2025
Certificate Expiration Date 7/31/2027
Facility Type Pharmacy
Lab Director KATHNEICELA V. PERRY

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This page was last updated on: 5/18/2026