45D2138075 CLIA NUMBER - WALMART PHARMACY 10-4183

Laboratory Demographics

  • CLIA Code: 45D2138075
  • Facility Name: WALMART PHARMACY 10-4183
  • Facility Address: 643 N HARVEY MITCHELL PARKWAY
    BRYAN, TX
    ZIP 77807
  • Facility Phone: 979 599-9208
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KARIANA PENA
  • NPI Number: 1255755393
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2138075
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4183
Street 643 N HARVEY MITCHELL PARKWAY
City BRYAN
State TX
ZIP 77807
Phone 979 599-9208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/10/2025
Certificate Expiration Date 10/9/2027
Facility Type Pharmacy
Lab Director KARIANA PENA

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