45D2118059 CLIA NUMBER - WALMART PHARMACY 10-3594

Laboratory Demographics

  • CLIA Code: 45D2118059
  • Facility Name: WALMART PHARMACY 10-3594
  • Facility Address: 2610 W PIONEER PARKWAY
    PANTEGO, TX
    ZIP 76013
  • Facility Phone: 817 303-4302
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM T. NGUYEN
  • NPI Number: 1659398790
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2118059
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3594
Street 2610 W PIONEER PARKWAY
City PANTEGO
State TX
ZIP 76013
Phone 817 303-4302
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Pharmacy
Lab Director KIM T. NGUYEN

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