49D2122488 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARCY #10-4350

Laboratory Demographics

  • CLIA Code: 49D2122488
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARCY #10-4350
  • Facility Address: 200 OLD FAIR GROUNDS WAY
    KILMARNOCK, VA
    ZIP 22482
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEANNA KIPLE
  • NPI Number: 1225222631
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 49D2122488
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARCY #10-4350
Street 200 OLD FAIR GROUNDS WAY
City KILMARNOCK
State VA
ZIP 22482
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 11/29/2024
Certificate Expiration Date 11/28/2026
Facility Type Pharmacy
Lab Director DEANNA KIPLE

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