45D2124494 CLIA NUMBER - WALMART PHARMACY 10-6300

Laboratory Demographics

  • CLIA Code: 45D2124494
  • Facility Name: WALMART PHARMACY 10-6300
  • Facility Address: 500 RICHLAND BOULEVARD
    PROSPER, TX
    ZIP 75078
  • Facility Phone: 972 347-9572
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY AGYEMAN-BADU
  • NPI Number: 1285168039
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2124494
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-6300
Street 500 RICHLAND BOULEVARD
City PROSPER
State TX
ZIP 75078
Phone 972 347-9572
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Pharmacy
Lab Director TRACY AGYEMAN-BADU

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