45D2138014 CLIA NUMBER - WALMART PHARMACY 10-0163

Laboratory Demographics

  • CLIA Code: 45D2138014
  • Facility Name: WALMART PHARMACY 10-0163
  • Facility Address: 4810 NORTH ST
    NACOGDOCHES, TX
    ZIP 75965
  • Facility Phone: 936 564-1158
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONALD R. MOORE
  • NPI Number: 1821015090
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2138014
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0163
Street 4810 NORTH ST
City NACOGDOCHES
State TX
ZIP 75965
Phone 936 564-1158
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2025
Certificate Expiration Date 10/8/2027
Facility Type Pharmacy
Lab Director DONALD R. MOORE

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