19D2141850 CLIA NUMBER - WALMART PHARMACY #10-2913

Laboratory Demographics

  • CLIA Code: 19D2141850
  • Facility Name: WALMART PHARMACY #10-2913
  • Facility Address: 13001 HIGHWAY 90
    BOUTTE, LA
    ZIP 70039
  • Facility Phone: 985 785-8586
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELISA THONG
  • NPI Number: 1417974783
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2141850
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2913
Street 13001 HIGHWAY 90
City BOUTTE
State LA
ZIP 70039
Phone 985 785-8586
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/22/2023
Certificate Expiration Date 12/21/2025
Facility Type Pharmacy
Lab Director ELISA THONG

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