19D2141853 CLIA NUMBER - WALMART PHARMACY #10-4129

Laboratory Demographics

  • CLIA Code: 19D2141853
  • Facility Name: WALMART PHARMACY #10-4129
  • Facility Address: 1331 HWY 51
    PONCHATOULA, LA
    ZIP 70454
  • Facility Phone: 985 467-8048
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONALD WILLIAMS
  • NPI Number: 1215351929
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2141853
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4129
Street 1331 HWY 51
City PONCHATOULA
State LA
ZIP 70454
Phone 985 467-8048
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 DONALD WILLIAMS

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