19D2101858 CLIA NUMBER - WALMART PHARMACY 10-6932

Laboratory Demographics

CLIA Number: 19D2101858

Facility Name: WALMART PHARMACY 10-6932

Facility Address:
4701 NORTHPORT BLVD
SHREVEPORT, LA
ZIP 71107
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Facility Phone Number: 479 273-6418

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336513993

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	19D2101858
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-6932
Street	4701 NORTHPORT BLVD
City	SHREVEPORT
State	LA
ZIP	71107
Phone	479 273-6418
CertificateType	4
CertificateEffectiveDate	9/11/2023
CertificateExpirationDate	9/10/2025
FacilityType	Waiver

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