18D2142931 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10

Laboratory Demographics

  • CLIA Code: 18D2142931
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10
  • Facility Address: 1405 MIDDLE ROAD
    FULTON, KY
    ZIP 42041
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL P. PRATHER
  • NPI Number: 1265459598
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 18D2142931
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10
Street 1405 MIDDLE ROAD
City FULTON
State KY
ZIP 42041
Phone 479 258-7034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Pharmacy
Lab Director MICHAEL P. PRATHER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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