45D2137958 CLIA NUMBER - WALMART PHARMACY 10-1042

Laboratory Demographics

  • CLIA Code: 45D2137958
  • Facility Name: WALMART PHARMACY 10-1042
  • Facility Address: 488 HIGHWAY 71 WEST
    BASTROP, TX
    ZIP 78602
  • Facility Phone: 512 321-1020
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAGIM T. NEGASH
  • NPI Number: 1497772644
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2137958
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1042
Street 488 HIGHWAY 71 WEST
City BASTROP
State TX
ZIP 78602
Phone 512 321-1020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2025
Certificate Expiration Date 10/5/2027
Facility Type Pharmacy
Lab Director DAGIM T. NEGASH

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