45D2139775 CLIA NUMBER - WALMART PHARMACY 10-0808

Laboratory Demographics

  • CLIA Code: 45D2139775
  • Facility Name: WALMART PHARMACY 10-0808
  • Facility Address: 121 HIGHWAY 332 W
    LAKE JACKSON, TX
    ZIP 77566
  • Facility Phone: 979 297-8578
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEVON ASPHALL
  • NPI Number: 1912924150
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2139775
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0808
Street 121 HIGHWAY 332 W
City LAKE JACKSON
State TX
ZIP 77566
Phone 979 297-8578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director DEVON ASPHALL

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