49D2117283 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1773

Laboratory Demographics

  • CLIA Code: 49D2117283
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1773
  • Facility Address: 12401 JEFFERSON AVENUE
    NEWPORT NEWS, VA
    ZIP 23602
  • Facility Phone: 479 258-6794
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENT KERRICK
  • NPI Number: 1376560474
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2117283
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1773
Street 12401 JEFFERSON AVENUE
City NEWPORT NEWS
State VA
ZIP 23602
Phone 479 258-6794
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Pharmacy
Lab Director BRENT KERRICK

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