45D2117226 CLIA NUMBER - WALMART PHARMACY 10-3043

Laboratory Demographics

CLIA Number: 45D2117226

Facility Name: WALMART PHARMACY 10-3043

Facility Address:
4536 HERITAGE TRACE PARKWAY
FORT WORTH, TX
ZIP 76244
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Facility Phone Number: 817 898-6076

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1619470770

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	45D2117226
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-3043
Street	4536 HERITAGE TRACE PARKWAY
City	FORT WORTH
State	TX
ZIP	76244
Phone	817 898-6076
CertificateType	4
CertificateEffectiveDate	8/11/2022
CertificateExpirationDate	8/10/2024
FacilityType	Waiver

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