19D2129665 CLIA NUMBER - WALMART PHARMACY 10-4048

Laboratory Demographics

  • CLIA Code: 19D2129665
  • Facility Name: WALMART PHARMACY 10-4048
  • Facility Address: 40567 LA HWY 42
    PRAIRIEVILLE, LA
    ZIP 70769
  • Facility Phone: (225) 622-4211
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHRYN A. BORDELON
  • NPI Number: 1407873771
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2129665
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4048
Street 40567 LA HWY 42
City PRAIRIEVILLE
State LA
ZIP 70769
Phone 2256224211
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Pharmacy
Lab Director KATHRYN A. BORDELON

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This page was last updated on: 5/18/2026