19D2140983 CLIA NUMBER - WALMART PHARMACY #10-278

Laboratory Demographics

  • CLIA Code: 19D2140983
  • Facility Name: WALMART PHARMACY #10-278
  • Facility Address: 1645 E BERT KOUNS INDUSTRIAL LOOP
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 797-9165
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHISH G. MODI
  • NPI Number: 1376561852
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2140983
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-278
Street 1645 E BERT KOUNS INDUSTRIAL LOOP
City SHREVEPORT
State LA
ZIP 71105
Phone 318 797-9165
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Pharmacy
Lab Director ASHISH G. MODI

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