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45D2138676 CLIA NUMBER - WALMART PHARMACY 10-1249

Laboratory Demographics

CLIA Number: 45D2138676

Facility Name: WALMART PHARMACY 10-1249

Facility Address:
610 W 29TH ST
SAN ANGELO, TX
ZIP 76903
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Facility Phone Number: 325 653-7088

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1104902451

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name Field Value
CLIA Number 45D2138676
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1249
Street 610 W 29TH ST
City SAN ANGELO
State TX
ZIP 76903
Phone 325 653-7088
CertificateType 4
CertificateEffectiveDate 10/23/2023
CertificateExpirationDate 10/22/2025
FacilityType Waiver

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