19D2141207 CLIA NUMBER - WALMART PHARMACY #10-1136

Laboratory Demographics

  • CLIA Code: 19D2141207
  • Facility Name: WALMART PHARMACY #10-1136
  • Facility Address: 3255 LA HIGHWAY 1 S
    PORT ALLEN, LA
    ZIP 70767
  • Facility Phone: 225 749-7454
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONNY A. BERTRAND
  • NPI Number: 1972520229
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2141207
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1136
Street 3255 LA HIGHWAY 1 S
City PORT ALLEN
State LA
ZIP 70767
Phone 225 749-7454
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2023
Certificate Expiration Date 12/10/2025
Facility Type Pharmacy
Lab Director DONNY A. BERTRAND

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