36D2121897 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1990

Laboratory Demographics

  • CLIA Code: 36D2121897
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1990
  • Facility Address: 1760 COLUMBUS PIKE
    DELAWARE, OH
    ZIP 43015
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ABENET KUMSSA
  • NPI Number: 1376560565
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2121897
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1990
Street 1760 COLUMBUS PIKE
City DELAWARE
State OH
ZIP 43015
Phone 479 258-7034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Pharmacy
Lab Director ABENET KUMSSA

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