45D2099217 CLIA NUMBER - WALMART PHARMACY 10-4618

Laboratory Demographics

  • CLIA Code: 45D2099217
  • Facility Name: WALMART PHARMACY 10-4618
  • Facility Address: 2625 W MAIN ST
    LEAGUE CITY, TX
    ZIP 77573
  • Facility Phone: 479 204-2272
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MINH VU NGUYET
  • NPI Number: 1114035409
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2099217
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4618
Street 2625 W MAIN ST
City LEAGUE CITY
State TX
ZIP 77573
Phone 479 204-2272
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/22/2023
Certificate Expiration Date 7/21/2025
Facility Type Pharmacy
Lab Director MINH VU NGUYET

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This page was last updated on: 3/20/2025