19D2142305 CLIA NUMBER - WALMART PHARMACY #10-1128

Laboratory Demographics

  • CLIA Code: 19D2142305
  • Facility Name: WALMART PHARMACY #10-1128
  • Facility Address: 7162 HIGHWAY 1
    MANSURA, LA
    ZIP 71350
  • Facility Phone: 318 253-4073
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY M. MOTON
  • NPI Number: 1336166685
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2142305
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1128
Street 7162 HIGHWAY 1
City MANSURA
State LA
ZIP 71350
Phone 318 253-4073
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Pharmacy
Lab Director TIMOTHY M. MOTON

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