34D2115869 CLIA NUMBER - WALMART STORES EAST, LP DBA WALMART PHARMACY 10-5298

Laboratory Demographics

  • CLIA Code: 34D2115869
  • Facility Name: WALMART STORES EAST, LP DBA WALMART PHARMACY 10-5298
  • Facility Address: 223 N MYRTLE SCHOOL ROAD
    GASTONIA, NC
    ZIP 28052
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRINCE BOAKYE
  • NPI Number: 1225055494
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2115869
LAB Type Pharmacy
Facility Name WALMART STORES EAST, LP DBA WALMART PHARMACY 10-5298
Street 223 N MYRTLE SCHOOL ROAD
City GASTONIA
State NC
ZIP 28052
Phone 479 258-6734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2024
Certificate Expiration Date 7/13/2026
Facility Type Pharmacy
Lab Director PRINCE BOAKYE

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