45D2138042 CLIA NUMBER - WALMART PHARMACY 10-0777

Laboratory Demographics

CLIA Number: 45D2138042

Facility Name: WALMART PHARMACY 10-0777

Facility Address:
3115 EDGAR BROWN DR
WEST ORANGE, TX
ZIP 77630
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Facility Phone Number: 409 882-0551

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376560508

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	45D2138042
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0777
Street	3115 EDGAR BROWN DR
City	WEST ORANGE
State	TX
ZIP	77630
Phone	409 882-0551
CertificateType	4
CertificateEffectiveDate	10/9/2023
CertificateExpirationDate	10/8/2025
FacilityType	Waiver

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