45D2120579 CLIA NUMBER - WALMART PHARMACY #10-6467

Laboratory Demographics

  • CLIA Code: 45D2120579
  • Facility Name: WALMART PHARMACY #10-6467
  • Facility Address: 450 S SOUTHEAST LOOP 323
    TYLER, TX
    ZIP 75702
  • Facility Phone: 903 405-6389
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AWUNG N. ASONG
  • NPI Number: 1972041374
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2120579
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-6467
Street 450 S SOUTHEAST LOOP 323
City TYLER
State TX
ZIP 75702
Phone 903 405-6389
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2024
Certificate Expiration Date 10/18/2026
Facility Type Pharmacy
Lab Director AWUNG N. ASONG

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