18D2144979 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-204

Laboratory Demographics

  • CLIA Code: 18D2144979
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-204
  • Facility Address: 1500 US HIGHWAY 62 W
    PRINCETON, KY
    ZIP 42445
  • Facility Phone: 270 365-9122
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEVEN WILSON
  • NPI Number: 1992722219
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2144979
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-204
Street 1500 US HIGHWAY 62 W
City PRINCETON
State KY
ZIP 42445
Phone 270 365-9122
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2024
Certificate Expiration Date 2/26/2026
Facility Type Pharmacy
Lab Director STEVEN WILSON

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