45D2099995 CLIA NUMBER - WALMART PHARMACY #10-4373

Laboratory Demographics

  • CLIA Code: 45D2099995
  • Facility Name: WALMART PHARMACY #10-4373
  • Facility Address: 200 WAKE VILLAGE ROAD
    TEXARKANA, TX
    ZIP 75501
  • Facility Phone: 903 716-7174
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMIL K. GOTTIMUKKALA
  • NPI Number: 1326426768
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2099995
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-4373
Street 200 WAKE VILLAGE ROAD
City TEXARKANA
State TX
ZIP 75501
Phone 903 716-7174
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2025
Certificate Expiration Date 8/4/2027
Facility Type Pharmacy
Lab Director AMIL K. GOTTIMUKKALA

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