45D2125816 CLIA NUMBER - WALMART PHARMACY 10-413

Laboratory Demographics

  • CLIA Code: 45D2125816
  • Facility Name: WALMART PHARMACY 10-413
  • Facility Address: 1401 STATE HIGHWAY 100
    PORT ISABEL, TX
    ZIP 78578
  • Facility Phone: 956 943-3512
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONALD FISCHER
  • NPI Number: 1992722151
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2125816
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-413
Street 1401 STATE HIGHWAY 100
City PORT ISABEL
State TX
ZIP 78578
Phone 956 943-3512
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/14/2025
Certificate Expiration Date 2/13/2027
Facility Type Pharmacy
Lab Director DONALD FISCHER

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