49D2130028 CLIA NUMBER - WALMART PHARMACY 10-5936

Laboratory Demographics

CLIA Number: 49D2130028

Facility Name: WALMART PHARMACY 10-5936

Facility Address:
1500 B CORNERSIDE BOULEVARD
VIENNA, VA
ZIP 22182
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Facility Phone Number: 571 623-3307

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1942648472

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	49D2130028
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-5936
Street	1500 B CORNERSIDE BOULEVARD
City	VIENNA
State	VA
ZIP	22182
Phone	571 623-3307
CertificateType	4
CertificateEffectiveDate	5/1/2023
CertificateExpirationDate	4/30/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024