45D2096512 CLIA NUMBER - WALMART PHARMACY 10-4453

Laboratory Demographics

  • CLIA Code: 45D2096512
  • Facility Name: WALMART PHARMACY 10-4453
  • Facility Address: 4715 WESLEY STREET
    GREENVILLE, TX
    ZIP 75401
  • Facility Phone: 903 259-5292
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY J. FARNHAM
  • NPI Number: 1093109589
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2096512
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4453
Street 4715 WESLEY STREET
City GREENVILLE
State TX
ZIP 75401
Phone 903 259-5292
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/27/2025
Certificate Expiration Date 5/26/2027
Facility Type Pharmacy
Lab Director TRACY J. FARNHAM

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