32D2133834 CLIA NUMBER - WALMART PHARMACY 10-2653

Laboratory Demographics

  • CLIA Code: 32D2133834
  • Facility Name: WALMART PHARMACY 10-2653
  • Facility Address: 1604 E SPRUCE STREET
    PORTALES, NM
    ZIP 88130
  • Facility Phone: 575 359-3435
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE D. BOYDSTON
  • NPI Number: 1609893759
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 32D2133834
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2653
Street 1604 E SPRUCE STREET
City PORTALES
State NM
ZIP 88130
Phone 575 359-3435
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director KYLE D. BOYDSTON

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