49D2116662 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1688

Laboratory Demographics

  • CLIA Code: 49D2116662
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1688
  • Facility Address: 657 PHOENIX DRIVE
    VIRGINIA BEACH, VA
    ZIP 23452
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOGAN LILLIOTT
  • NPI Number: 1952328155
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2116662
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1688
Street 657 PHOENIX DRIVE
City VIRGINIA BEACH
State VA
ZIP 23452
Phone 479 258-6734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/29/2024
Certificate Expiration Date 7/28/2026
Facility Type Pharmacy
Lab Director LOGAN LILLIOTT

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