34D2115903 CLIA NUMBER - WALMART STORES EAST, LP DBA WALMART PHARMACY 10-2005

Laboratory Demographics

  • CLIA Code: 34D2115903
  • Facility Name: WALMART STORES EAST, LP DBA WALMART PHARMACY 10-2005
  • Facility Address: 2420 SUPERCENTER DRIVE NE
    KANNAPOLIS, NC
    ZIP 28083
  • Facility Phone: 704 792-9830
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GRANT G. LIM
  • NPI Number: 1114944378
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2115903
LAB Type Pharmacy
Facility Name WALMART STORES EAST, LP DBA WALMART PHARMACY 10-2005
Street 2420 SUPERCENTER DRIVE NE
City KANNAPOLIS
State NC
ZIP 28083
Phone 704 792-9830
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 GRANT G. LIM

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