15D2125511 CLIA NUMBER - WAL-MART STORES EAST, LP D/B/A WAL-MART PHARMACY #10-4054

Laboratory Demographics

  • CLIA Code: 15D2125511
  • Facility Name: WAL-MART STORES EAST, LP D/B/A WAL-MART PHARMACY #10-4054
  • Facility Address: 4837 KENTUCKY AVE
    INDIANAPOLIS, IN
    ZIP 46221
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUAY ABUHASSAN
  • NPI Number: 1306224696
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 15D2125511
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP D/B/A WAL-MART PHARMACY #10-4054
Street 4837 KENTUCKY AVE
City INDIANAPOLIS
State IN
ZIP 46221
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 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Pharmacy
Lab Director LUAY ABUHASSAN

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