45D2135922 CLIA NUMBER - WALMART PHARMACY 10-2688

Laboratory Demographics

CLIA Number: 45D2135922

Facility Name: WALMART PHARMACY 10-2688

Facility Address:
6801 S BROADWAY AVE
TYLER, TX
ZIP 75703
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Facility Phone Number: 903 581-4842

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1124047139

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	45D2135922
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-2688
Street	6801 S BROADWAY AVE
City	TYLER
State	TX
ZIP	75703
Phone	903 581-4842
CertificateType	4
CertificateEffectiveDate	8/30/2023
CertificateExpirationDate	8/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024