36D2123662 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5410

Laboratory Demographics

  • CLIA Code: 36D2123662
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5410
  • Facility Address: 4004 W TUSCARAWAS ST
    CANTON, OH
    ZIP 44708
  • Facility Phone: (330) 479-9630
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN M. FUSSELMAN
  • NPI Number: 1497772594
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2123662
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-5410
Street 4004 W TUSCARAWAS ST
City CANTON
State OH
ZIP 44708
Phone 3304799630
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2024
Certificate Expiration Date 12/27/2026
Facility Type Pharmacy
Lab Director KEVIN M. FUSSELMAN

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This page was last updated on: 5/18/2026