45D2127321 CLIA NUMBER - WALMART PHARMACY 10-1098

Laboratory Demographics

  • CLIA Code: 45D2127321
  • Facility Name: WALMART PHARMACY 10-1098
  • Facility Address: 400 TINY BROWNING BLVD
    PORT LAVACA, TX
    ZIP 77979
  • Facility Phone: 361 552-1788
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EDITH WILLETT
  • NPI Number: 1841217098
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2127321
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1098
Street 400 TINY BROWNING BLVD
City PORT LAVACA
State TX
ZIP 77979
Phone 361 552-1788
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2025
Certificate Expiration Date 3/12/2027
Facility Type Pharmacy
Lab Director EDITH WILLETT

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