45D2139887 CLIA NUMBER - WALMART PHARMACY 10-3591

Laboratory Demographics

CLIA Number: 45D2139887

Facility Name: WALMART PHARMACY 10-3591

Facility Address:
18700 HIGHWAY 105 W
MONTGOMERY, TX
ZIP 77356
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Facility Phone Number: 936 582-1005

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1770501470

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	45D2139887
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-3591
Street	18700 HIGHWAY 105 W
City	MONTGOMERY
State	TX
ZIP	77356
Phone	936 582-1005
CertificateType	4
CertificateEffectiveDate	11/10/2023
CertificateExpirationDate	11/9/2025
FacilityType	Waiver

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