45D2117046 CLIA NUMBER - WALMART PHARMACY 10-896

Laboratory Demographics

  • CLIA Code: 45D2117046
  • Facility Name: WALMART PHARMACY 10-896
  • Facility Address: 2225 W INTERSTATE 20
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 660-8500
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUCRETIA M. THOMAS
  • NPI Number: 1871510024
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117046
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-896
Street 2225 W INTERSTATE 20
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 660-8500
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 LUCRETIA M. THOMAS

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