45D2136688 CLIA NUMBER - WALMART PHARMACY 10-3169

Laboratory Demographics

  • CLIA Code: 45D2136688
  • Facility Name: WALMART PHARMACY 10-3169
  • Facility Address: 11923 US HWY 290 E
    MANOR, TX
    ZIP 78653
  • Facility Phone: 512 651-9128
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SATYA KANTIPUDI
  • NPI Number: 1972924876
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2136688
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3169
Street 11923 US HWY 290 E
City MANOR
State TX
ZIP 78653
Phone 512 651-9128
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Pharmacy
Lab Director SATYA KANTIPUDI

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