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36D2121894 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2211

Laboratory Demographics

CLIA Number: 36D2121894

Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2211

Facility Address:
1300 DORAL DRIVE
POLAND, OH
ZIP 44514
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Facility Phone Number: 479 258-7034

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1659398840

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 36D2121894
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2211
Street 1300 DORAL DRIVE
City POLAND
State OH
ZIP 44514
Phone 479 258-7034
CertificateType 4
CertificateEffectiveDate 11/16/2022
CertificateExpirationDate 11/15/2024
FacilityType Waiver

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