45D2119703 CLIA NUMBER - WALMART PHARMACY 10-3773

Laboratory Demographics

  • CLIA Code: 45D2119703
  • Facility Name: WALMART PHARMACY 10-3773
  • Facility Address: 9500 CLIFFORD STREET
    FORT WORTH, TX
    ZIP 76108
  • Facility Phone: 817 367-0818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EBRAM KHALIL
  • NPI Number: 1962420729
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2119703
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3773
Street 9500 CLIFFORD STREET
City FORT WORTH
State TX
ZIP 76108
Phone 817 367-0818
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2024
Certificate Expiration Date 10/2/2026
Facility Type Pharmacy
Lab Director EBRAM KHALIL

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