18D2121142 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARAMACY #10-2628

Laboratory Demographics

  • CLIA Code: 18D2121142
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARAMACY #10-2628
  • Facility Address: 4051 NICHOLASVILLE RD
    LEXINGTON, KY
    ZIP 40503
  • Facility Phone: 859 971-0583
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. MICHAEL K. BURLESON
  • NPI Number: 1528085859
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2121142
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARAMACY #10-2628
Street 4051 NICHOLASVILLE RD
City LEXINGTON
State KY
ZIP 40503
Phone 859 971-0583
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/1/2024
Certificate Expiration Date 10/31/2026
Facility Type Pharmacy
Lab Director MR. MICHAEL K. BURLESON

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