19D2134532 CLIA NUMBER - WALMART PHARMACY 10-0469

Laboratory Demographics

  • CLIA Code: 19D2134532
  • Facility Name: WALMART PHARMACY 10-0469
  • Facility Address: 3415 HIGHWAY 14
    LAKE CHARLES, LA
    ZIP 70607
  • Facility Phone: 337 474-3503
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE F. GARDNER
  • NPI Number: 1164440673
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2134532
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0469
Street 3415 HIGHWAY 14
City LAKE CHARLES
State LA
ZIP 70607
Phone 337 474-3503
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2025
Certificate Expiration Date 8/3/2027
Facility Type Pharmacy
Lab Director KYLE F. GARDNER

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