36D2121911 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART #10-3860

Laboratory Demographics

  • CLIA Code: 36D2121911
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART #10-3860
  • Facility Address: 200 GOLDIE ROAD
    YOUNGSTOWN, OH
    ZIP 44505
  • Facility Phone: 330 759-2689
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICOLE C. CHAMMAS
  • NPI Number: 1558598466
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2121911
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART #10-3860
Street 200 GOLDIE ROAD
City YOUNGSTOWN
State OH
ZIP 44505
Phone 330 759-2689
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 NICOLE C. CHAMMAS

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