49D2117291 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1524

Laboratory Demographics

  • CLIA Code: 49D2117291
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1524
  • Facility Address: 12000 IRON BRIDGE ROAD
    CHESTER, VA
    ZIP 23831
  • Facility Phone: 804 768-0273
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RACHEL A. GONZALO
  • NPI Number: 1548287642
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2117291
LAB Type Physician Office
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-1524
Street 12000 IRON BRIDGE ROAD
City CHESTER
State VA
ZIP 23831
Phone 804 768-0273
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 Physician Office
Lab Director RACHEL A. GONZALO

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