19D2129671 CLIA NUMBER - WALMART PHARMACY 10-448

Laboratory Demographics

  • CLIA Code: 19D2129671
  • Facility Name: WALMART PHARMACY 10-448
  • Facility Address: 6235 W PORT AVE
    SHREVEPORT, LA
    ZIP 71129
  • Facility Phone: 318 688-7705
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HOWARD W. TYNDALL
  • NPI Number: 1528085867
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2129671
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-448
Street 6235 W PORT AVE
City SHREVEPORT
State LA
ZIP 71129
Phone 318 688-7705
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 HOWARD W. TYNDALL

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