45D2119520 CLIA NUMBER - WALMART PHARMACY 10-1178

Laboratory Demographics

  • CLIA Code: 45D2119520
  • Facility Name: WALMART PHARMACY 10-1178
  • Facility Address: 4101 HIGHWAY 121
    BEDFORD, TX
    ZIP 76021
  • Facility Phone: 817 571-6222
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLGA VONTELA
  • NPI Number: 1982621140
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2119520
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1178
Street 4101 HIGHWAY 121
City BEDFORD
State TX
ZIP 76021
Phone 817 571-6222
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 OLGA VONTELA

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