49D2116743 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3157

Laboratory Demographics

  • CLIA Code: 49D2116743
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3157
  • Facility Address: 11214 JEFFERSON AVENUE
    NEWPORT NEWS, VA
    ZIP 23601
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMEELAH POULSON
  • NPI Number: 1386988715
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2116743
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3157
Street 11214 JEFFERSON AVENUE
City NEWPORT NEWS
State VA
ZIP 23601
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 8/1/2024
Certificate Expiration Date 7/31/2026
Facility Type Pharmacy
Lab Director JAMEELAH POULSON

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