19D2113158 CLIA NUMBER - WALMART PHARMACY 10-3752

Laboratory Demographics

  • CLIA Code: 19D2113158
  • Facility Name: WALMART PHARMACY 10-3752
  • Facility Address: 5700 SHED ROAD
    BOSSIER CITY, LA
    ZIP 71111
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KANETHIA DANIEL
  • NPI Number: 1073530341
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2113158
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3752
Street 5700 SHED ROAD
City BOSSIER CITY
State LA
ZIP 71111
Phone 479 258-2243
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/17/2024
Certificate Expiration Date 5/16/2026
Facility Type Pharmacy
Lab Director KANETHIA DANIEL

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