45D2101447 CLIA NUMBER - WALMART PHARMACY 10-0972

Laboratory Demographics

CLIA Number: 45D2101447

Facility Name: WALMART PHARMACY 10-0972

Facility Address:
6360 LAKE WORTH BLVD
LAKE WORTH, TX
ZIP 76135
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Facility Phone Number: 817 237-1118

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861419012

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	45D2101447
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0972
Street	6360 LAKE WORTH BLVD
City	LAKE WORTH
State	TX
ZIP	76135
Phone	817 237-1118
CertificateType	4
CertificateEffectiveDate	9/2/2023
CertificateExpirationDate	9/1/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024