18D2145157 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5418

Laboratory Demographics

CLIA Number: 18D2145157

Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5418

Facility Address:
2020 BASHFORD MANOR LANE
LOUISVILLE, KY
ZIP 40218
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Facility Phone Number: 502 451-6822

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1508883836

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	18D2145157
LAB Type	Pharmacy
Facility Name	WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5418
Street	2020 BASHFORD MANOR LANE
City	LOUISVILLE
State	KY
ZIP	40218
Phone	502 451-6822
CertificateType	4
CertificateEffectiveDate	3/2/2024
CertificateExpirationDate	3/1/2026
FacilityType	Waiver

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