45D2117404 CLIA NUMBER - WALMART PHARMACY 10-4165

Laboratory Demographics

  • CLIA Code: 45D2117404
  • Facility Name: WALMART PHARMACY 10-4165
  • Facility Address: 2245 JACKSBORO HIGHWAY
    FORT WORTH, TX
    ZIP 76114
  • Facility Phone: 817 569-6241
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEY N. CAMACHO
  • NPI Number: 1184032955
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117404
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4165
Street 2245 JACKSBORO HIGHWAY
City FORT WORTH
State TX
ZIP 76114
Phone 817 569-6241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2024
Certificate Expiration Date 8/15/2026
Facility Type Pharmacy
Lab Director ASHLEY N. CAMACHO

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