45D2117421 CLIA NUMBER - WALMART PHARMACY 10-3406

Laboratory Demographics

  • CLIA Code: 45D2117421
  • Facility Name: WALMART PHARMACY 10-3406
  • Facility Address: 15220 MONTFORT DR
    DALLAS, TX
    ZIP 75248
  • Facility Phone: 972 233-8764
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY FARAG GHOBRIAL
  • NPI Number: 1649351172
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2117421
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3406
Street 15220 MONTFORT DR
City DALLAS
State TX
ZIP 75248
Phone 972 233-8764
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 MARY FARAG GHOBRIAL

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