45D2135919 CLIA NUMBER - WALMART PHARMACY 10-3764

Laboratory Demographics

  • CLIA Code: 45D2135919
  • Facility Name: WALMART PHARMACY 10-3764
  • Facility Address: 105 CENTENNIAL BLVD
    LINDALE, TX
    ZIP 75771
  • Facility Phone: 903 882-5840
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RONDA J. DIETZEL
  • NPI Number: 1811914989
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2135919
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3764
Street 105 CENTENNIAL BLVD
City LINDALE
State TX
ZIP 75771
Phone 903 882-5840
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Pharmacy
Lab Director RONDA J. DIETZEL

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