44D2140397 CLIA NUMBER - WALMART PHARMACY 10-0599

Laboratory Demographics

CLIA Number: 44D2140397

Facility Name: WALMART PHARMACY 10-0599

Facility Address:
3200 FT HENRY DRIVE
KINGSPORT, TN
ZIP 37664
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Facility Phone Number: 423 392-9860

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1427075613

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	44D2140397
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0599
Street	3200 FT HENRY DRIVE
City	KINGSPORT
State	TN
ZIP	37664
Phone	423 392-9860
CertificateType	4
CertificateEffectiveDate	11/21/2023
CertificateExpirationDate	11/20/2025
FacilityType	Waiver

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