45D2117129 CLIA NUMBER - WALMART PHARMACY 10-2397

Laboratory Demographics

  • CLIA Code: 45D2117129
  • Facility Name: WALMART PHARMACY 10-2397
  • Facility Address: 2951 MATLOCK ROAD
    MANSFIELD, TX
    ZIP 76063
  • Facility Phone: 817 453-5635
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIN N. TRAN
  • NPI Number: 1104843218
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117129
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2397
Street 2951 MATLOCK ROAD
City MANSFIELD
State TX
ZIP 76063
Phone 817 453-5635
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Pharmacy
Lab Director TIN N. TRAN

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