18D2143190 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-584

Laboratory Demographics

  • CLIA Code: 18D2143190
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-584
  • Facility Address: 20 FERGUSON BLVD
    DRY RIDGE, KY
    ZIP 41035
  • Facility Phone: 859 824-5091
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES CHILDERS
  • NPI Number: 1356368682
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2143190
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-584
Street 20 FERGUSON BLVD
City DRY RIDGE
State KY
ZIP 41035
Phone 859 824-5091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/25/2024
Certificate Expiration Date 1/24/2026
Facility Type Pharmacy
Lab Director CHARLES CHILDERS

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