45D2117039 CLIA NUMBER - WALMART PHARMACY 10-476

Laboratory Demographics

  • CLIA Code: 45D2117039
  • Facility Name: WALMART PHARMACY 10-476
  • Facility Address: 2805 S STATE HIGHWAY 36
    GATESVILLE, TX
    ZIP 76528
  • Facility Phone: 254 248-1130
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLEY R. RALEY
  • NPI Number: 1902823172
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117039
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-476
Street 2805 S STATE HIGHWAY 36
City GATESVILLE
State TX
ZIP 76528
Phone 254 248-1130
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/8/2024
Certificate Expiration Date 8/7/2026
Facility Type Pharmacy
Lab Director KELLEY R. RALEY

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