49D2117295 CLIA NUMBER - WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5488

Laboratory Demographics

  • CLIA Code: 49D2117295
  • Facility Name: WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5488
  • Facility Address: 7530 TIDEWATER DRIVE
    NORFOLK, VA
    ZIP 23505
  • Facility Phone: 757 480-3051
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON R. SPROUSE
  • NPI Number: 1639234768
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2117295
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP WAL-MART PHARMACY 10-5488
Street 7530 TIDEWATER DRIVE
City NORFOLK
State VA
ZIP 23505
Phone 757 480-3051
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 JASON R. SPROUSE

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