45D2117231 CLIA NUMBER - WALMART PHARMACY 10-3287

Laboratory Demographics

  • CLIA Code: 45D2117231
  • Facility Name: WALMART PHARMACY 10-3287
  • Facility Address: 1515 JUSTIN ROAD
    LEWISVILLE, TX
    ZIP 75077
  • Facility Phone: 972 966-6518
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AGBOR IMUETINYANOSA
  • NPI Number: 1215954359
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117231
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3287
Street 1515 JUSTIN ROAD
City LEWISVILLE
State TX
ZIP 75077
Phone 972 966-6518
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 AGBOR IMUETINYANOSA

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