15D2124298 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-7087

Laboratory Demographics

  • CLIA Code: 15D2124298
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-7087
  • Facility Address: 1309 E HACKBERRY ST
    SALEM, IN
    ZIP 47167
  • Facility Phone: (479) 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT EARL DAVIS II
  • NPI Number: 1205380474
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2124298
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-7087
Street 1309 E HACKBERRY ST
City SALEM
State IN
ZIP 47167
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 ROBERT EARL DAVIS II

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