45D2101217 CLIA NUMBER - WALMART PHARMACY 10-4674

Laboratory Demographics

  • CLIA Code: 45D2101217
  • Facility Name: WALMART PHARMACY 10-4674
  • Facility Address: 1030 N UNIVERSITY DRIVE
    NACOGDOCHES, TX
    ZIP 75961
  • Facility Phone: 936 585-7810
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KANG NI R. WU
  • NPI Number: 1538531520
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2101217
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4674
Street 1030 N UNIVERSITY DRIVE
City NACOGDOCHES
State TX
ZIP 75961
Phone 936 585-7810
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2025
Certificate Expiration Date 8/30/2027
Facility Type Pharmacy
Lab Director KANG NI R. WU

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