45D2117480 CLIA NUMBER - WALMART (SAMS CLUB) PHARMACY 10 5191

Laboratory Demographics

  • CLIA Code: 45D2117480
  • Facility Name: WALMART (SAMS CLUB) PHARMACY 10 5191
  • Facility Address: 802 E US HIGHWAY 80
    FORNEY, TX
    ZIP 75126
  • Facility Phone: 972 564-9160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WHITNEY KAUTZ
  • NPI Number: 1558388611
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2117480
LAB Type Pharmacy
Facility Name WALMART (SAMS CLUB) PHARMACY 10 5191
Street 802 E US HIGHWAY 80
City FORNEY
State TX
ZIP 75126
Phone 972 564-9160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type Pharmacy
Lab Director WHITNEY KAUTZ

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