45D2117226 CLIA NUMBER - WALMART PHARMACY 10-3043

Laboratory Demographics

  • CLIA Code: 45D2117226
  • Facility Name: WALMART PHARMACY 10-3043
  • Facility Address: 4536 HERITAGE TRACE PARKWAY
    FORT WORTH, TX
    ZIP 76244
  • Facility Phone: 817 898-6076
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORGE PEIDRA
  • NPI Number: 1619470770
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2024
Certificate Expiration Date 8/10/2026
Facility Type Pharmacy
Lab Director JORGE PEIDRA

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