18D2122388 CLIA NUMBER - WAL-MART/SAM'S CLUB PHARMACY I0-1259

Laboratory Demographics

CLIA Number: 18D2122388

Facility Name: WAL-MART/SAM'S CLUB PHARMACY I0-1259

Facility Address:
60 S STEWART RD
CORBIN, KY
ZIP 40701
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Facility Phone Number: 606 523-2206

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093732315

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	18D2122388
LAB Type	Pharmacy
Facility Name	WAL-MART/SAM'S CLUB PHARMACY I0-1259
Street	60 S STEWART RD
City	CORBIN
State	KY
ZIP	40701
Phone	606 523-2206
CertificateType	4
CertificateEffectiveDate	11/29/2022
CertificateExpirationDate	11/28/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024