36D2121919 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2149

Laboratory Demographics

  • CLIA Code: 36D2121919
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2149
  • Facility Address: 1575 COSHOCTON AVENUE
    MOUNT VERNON, OH
    ZIP 43050
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA BOCOCK
  • NPI Number: 1457378648
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2121919
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-2149
Street 1575 COSHOCTON AVENUE
City MOUNT VERNON
State OH
ZIP 43050
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 MELISSA BOCOCK

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