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44D2139687 CLIA NUMBER - WALMART PHARMACY 10-0724

Laboratory Demographics

CLIA Number: 44D2139687

Facility Name: WALMART PHARMACY 10-0724

Facility Address:
630 E BROADWAY BLVD
JEFFERSON CITY, TN
ZIP 37760
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Facility Phone Number: 865 475-3736

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1760409940

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 44D2139687
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0724
Street 630 E BROADWAY BLVD
City JEFFERSON CITY
State TN
ZIP 37760
Phone 865 475-3736
CertificateType 4
CertificateEffectiveDate 11/7/2023
CertificateExpirationDate 11/6/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024