37D2154295 CLIA NUMBER - WALMART PHARMACY 10-5093

Laboratory Demographics

  • CLIA Code: 37D2154295
  • Facility Name: WALMART PHARMACY 10-5093
  • Facility Address: 4404 S PEORIA AVE
    TULSA, OK
    ZIP 74105
  • Facility Phone: 918 749-1607
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESS M. TREVINO
  • NPI Number: 1144247289
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2154295
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5093
Street 4404 S PEORIA AVE
City TULSA
State OK
ZIP 74105
Phone 918 749-1607
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Pharmacy
Lab Director JESS M. TREVINO

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