45D2119515 CLIA NUMBER - WALMART PHARMACY 10-266

Laboratory Demographics

  • CLIA Code: 45D2119515
  • Facility Name: WALMART PHARMACY 10-266
  • Facility Address: 1601 W STATE HIGHWAY 114
    GRAPEVINE, TX
    ZIP 76051
  • Facility Phone: 817 488-6682
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TERESA BRUNO
  • NPI Number: 1104843341
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2119515
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-266
Street 1601 W STATE HIGHWAY 114
City GRAPEVINE
State TX
ZIP 76051
Phone 817 488-6682
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Pharmacy
Lab Director TERESA BRUNO

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