19D2142810 CLIA NUMBER - WALMART PHARMACY #10-1102

Laboratory Demographics

  • CLIA Code: 19D2142810
  • Facility Name: WALMART PHARMACY #10-1102
  • Facility Address: 14507 PLANK RD
    BAKER, LA
    ZIP 70714
  • Facility Phone: 225 774-2047
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EVAN R. GLASGOW
  • NPI Number: 1427075779
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2142810
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1102
Street 14507 PLANK RD
City BAKER
State LA
ZIP 70714
Phone 225 774-2047
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Pharmacy
Lab Director EVAN R. GLASGOW

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