45D2134769 CLIA NUMBER - WALMART 10-470

Laboratory Demographics

  • CLIA Code: 45D2134769
  • Facility Name: WALMART 10-470
  • Facility Address: 1821 SOUTH PADRE ISLAND DRIVE
    CORPUS CHRISTI, TX
    ZIP 78416
  • Facility Phone: 361 854-5804
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHAM RUSELLE
  • NPI Number: 1790702959
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2134769
LAB Type Pharmacy
Facility Name WALMART 10-470
Street 1821 SOUTH PADRE ISLAND DRIVE
City CORPUS CHRISTI
State TX
ZIP 78416
Phone 361 854-5804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2025
Certificate Expiration Date 8/8/2027
Facility Type Pharmacy
Lab Director PHAM RUSELLE

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