45D2123990 CLIA NUMBER - WALMART PHARMACY 10-0400

Laboratory Demographics

  • CLIA Code: 45D2123990
  • Facility Name: WALMART PHARMACY 10-0400
  • Facility Address: 1407 NORTH LOOP 336 WEST
    CONROE, TX
    ZIP 77304
  • Facility Phone: 936 760-2112
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMUEL T. THAN
  • NPI Number: 1649297870
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2123990
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0400
Street 1407 NORTH LOOP 336 WEST
City CONROE
State TX
ZIP 77304
Phone 936 760-2112
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Pharmacy
Lab Director SAMUEL T. THAN

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