18D2144980 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1053

Laboratory Demographics

  • CLIA Code: 18D2144980
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1053
  • Facility Address: 1015 NEW MOODY LANE
    LA GRANGE, KY
    ZIP 40031
  • Facility Phone: 502 222-9797
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DENNIS CROMER
  • NPI Number: 1174540405
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2144980
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1053
Street 1015 NEW MOODY LANE
City LA GRANGE
State KY
ZIP 40031
Phone 502 222-9797
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 DENNIS CROMER

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