19D2098080 CLIA NUMBER - WALMART PHARMACY 10-4577

Laboratory Demographics

  • CLIA Code: 19D2098080
  • Facility Name: WALMART PHARMACY 10-4577
  • Facility Address: 321 WEST CALIFORNIA AVE
    RUSTON, LA
    ZIP 71270
  • Facility Phone: 318 497-6232
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AARON R. CLARK
  • NPI Number: 1518984855
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2098080
LAB Type Physician Office
Facility Name WALMART PHARMACY 10-4577
Street 321 WEST CALIFORNIA AVE
City RUSTON
State LA
ZIP 71270
Phone 318 497-6232
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Physician Office
Lab Director AARON R. CLARK

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