36D2121901 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART #10-1895

Laboratory Demographics

  • CLIA Code: 36D2121901
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART #10-1895
  • Facility Address: 3750-I WEST MARKET STREET
    FAIRLAWN, OH
    ZIP 44333
  • Facility Phone: 330 666-0742
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW W. JACKSON
  • NPI Number: 1730106923
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2121901
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART #10-1895
Street 3750-I WEST MARKET STREET
City FAIRLAWN
State OH
ZIP 44333
Phone 330 666-0742
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 ANDREW W. JACKSON

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