45D2138015 CLIA NUMBER - WALMART PHARMACY 10-0165

Laboratory Demographics

  • CLIA Code: 45D2138015
  • Facility Name: WALMART PHARMACY 10-0165
  • Facility Address: 2121 US HIGHWAY 79 SOUTH
    HENDERSON, TX
    ZIP 75654
  • Facility Phone: 903 657-2757
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEXANDER G. MELINO
  • NPI Number: 1639197460
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2138015
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0165
Street 2121 US HIGHWAY 79 SOUTH
City HENDERSON
State TX
ZIP 75654
Phone 903 657-2757
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 ALEXANDER G. MELINO

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