20D2126119 CLIA NUMBER - WAL-MART STORES EAST DBA WAL-MART PHARMACY #10-1866

Laboratory Demographics

  • CLIA Code: 20D2126119
  • Facility Name: WAL-MART STORES EAST DBA WAL-MART PHARMACY #10-1866
  • Facility Address: 615 WILTON ROAD
    FARMINGTON, ME
    ZIP 04938
  • Facility Phone: (479) 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAYMOUND V. BLOOM
  • NPI Number: 1730106006
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 20D2126119
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST DBA WAL-MART PHARMACY #10-1866
Street 615 WILTON ROAD
City FARMINGTON
State ME
ZIP 04938
Phone 4792586734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2025
Certificate Expiration Date 2/20/2027
Facility Type Pharmacy
Lab Director RAYMOUND V. BLOOM

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This page was last updated on: 5/18/2026