45D2103921 CLIA NUMBER - WALMART PHARMACY 10-4115

Laboratory Demographics

CLIA Number: 45D2103921

Facility Name: WALMART PHARMACY 10-4115

Facility Address:
602 CIBOLO VALLEY DRIVE
CIBOLO, TX
ZIP 78108
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Facility Phone Number: 210 659-9245

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1174902027

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	45D2103921
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-4115
Street	602 CIBOLO VALLEY DRIVE
City	CIBOLO
State	TX
ZIP	78108
Phone	210 659-9245
CertificateType	4
CertificateEffectiveDate	10/22/2023
CertificateExpirationDate	10/21/2025
FacilityType	Waiver

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