45D2122886 CLIA NUMBER - WALMART PHARMACY 10-286

Laboratory Demographics

  • CLIA Code: 45D2122886
  • Facility Name: WALMART PHARMACY 10-286
  • Facility Address: 700 E ENNIS AVE
    ENNIS, TX
    ZIP 75119
  • Facility Phone: 972 875-9636
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN PAUL SUPAK
  • NPI Number: 1255358420
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2122886
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-286
Street 700 E ENNIS AVE
City ENNIS
State TX
ZIP 75119
Phone 972 875-9636
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 JOHN PAUL SUPAK

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