45D2136688 CLIA NUMBER - WALMART PHARMACY 10-3169

Laboratory Demographics

CLIA Number: 45D2136688

Facility Name: WALMART PHARMACY 10-3169

Facility Address:
11923 US HWY 290 E
MANOR, TX
ZIP 78653
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Facility Phone Number: 512 651-9128

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1972924876

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	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
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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