19D2145578 CLIA NUMBER - WALMART PHARMACY #10-1016

Laboratory Demographics

  • CLIA Code: 19D2145578
  • Facility Name: WALMART PHARMACY #10-1016
  • Facility Address: 410 N CANAL BLVD
    THIBODAUX, LA
    ZIP 70301
  • Facility Phone: 985 446-3637
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY E. MIRE
  • NPI Number: 1073530325
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2145578
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1016
Street 410 N CANAL BLVD
City THIBODAUX
State LA
ZIP 70301
Phone 985 446-3637
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2024
Certificate Expiration Date 3/11/2026
Facility Type Pharmacy
Lab Director MARY E. MIRE

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