45D2122870 CLIA NUMBER - WALMART PHARMACY 10-158

Laboratory Demographics

  • CLIA Code: 45D2122870
  • Facility Name: WALMART PHARMACY 10-158
  • Facility Address: 2021 NORTH STATE HIGHWAY 121
    BONHAM, TX
    ZIP 75418
  • Facility Phone: (903) 583-5564
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WARD R. CLEMENTS
  • NPI Number: 1871510065
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2122870
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-158
Street 2021 NORTH STATE HIGHWAY 121
City BONHAM
State TX
ZIP 75418
Phone 9035835564
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/8/2024
Certificate Expiration Date 12/7/2026
Facility Type Pharmacy
Lab Director WARD R. CLEMENTS

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This page was last updated on: 5/18/2026