45D2137533 CLIA NUMBER - WALMART (SAM'S CLUB) PHARMACY 10-0457

Laboratory Demographics

  • CLIA Code: 45D2137533
  • Facility Name: WALMART (SAM'S CLUB) PHARMACY 10-0457
  • Facility Address: 1360 NORTH MAIN ST
    VIDOR, TX
    ZIP 77662
  • Facility Phone: 409 769-1691
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JONATHAN W. DELONG
  • NPI Number: 1457378630
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2137533
LAB Type Pharmacy
Facility Name WALMART (SAM'S CLUB) PHARMACY 10-0457
Street 1360 NORTH MAIN ST
City VIDOR
State TX
ZIP 77662
Phone 409 769-1691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2025
Certificate Expiration Date 9/27/2027
Facility Type Pharmacy
Lab Director JONATHAN W. DELONG

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