15D2124290 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-4053

Laboratory Demographics

  • CLIA Code: 15D2124290
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-4053
  • Facility Address: 5555 MICHIGAN RD
    INDIANAPOLIS, IN
    ZIP 46228
  • Facility Phone: (479) 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRITI PATEL
  • NPI Number: 1801209796
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2124290
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-4053
Street 5555 MICHIGAN RD
City INDIANAPOLIS
State IN
ZIP 46228
Phone 4792586734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2025
Certificate Expiration Date 1/11/2027
Facility Type Pharmacy
Lab Director PRITI PATEL

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This page was last updated on: 5/15/2026