19D2140270 CLIA NUMBER - WALMART PHARMACY 10-415

Laboratory Demographics

  • CLIA Code: 19D2140270
  • Facility Name: WALMART PHARMACY 10-415
  • Facility Address: 123 SAINT NAZAIRE RD
    BROUSSARD, LA
    ZIP 70518
  • Facility Phone: 337 837-8131
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CANDACE K. FRAZIER
  • NPI Number: 1508883869
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2140270
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-415
Street 123 SAINT NAZAIRE RD
City BROUSSARD
State LA
ZIP 70518
Phone 337 837-8131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2023
Certificate Expiration Date 11/16/2025
Facility Type Pharmacy
Lab Director CANDACE K. FRAZIER

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