15D2124295 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1580

Laboratory Demographics

  • CLIA Code: 15D2124295
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1580
  • Facility Address: 10617 E WASHINGTON ST
    INDIANAPOLIS, IN
    ZIP 46229
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOHAMED WALEED ABDEL AZIZ
  • NPI Number: 1861411845
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2124295
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1580
Street 10617 E WASHINGTON ST
City INDIANAPOLIS
State IN
ZIP 46229
Phone 479 258-6734
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 MOHAMED WALEED ABDEL AZIZ

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