49D2116762 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1523

Laboratory Demographics

  • CLIA Code: 49D2116762
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1523
  • Facility Address: 11400 W BROAD ST
    GLEN ALLEN, VA
    ZIP 23060
  • Facility Phone: (804) 360-9782
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATRICK E. PAUL
  • NPI Number: 1407873607
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2116762
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1523
Street 11400 W BROAD ST
City GLEN ALLEN
State VA
ZIP 23060
Phone 8043609782
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 PATRICK E. PAUL

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