45D2139887 CLIA NUMBER - WALMART PHARMACY 10-3591

Laboratory Demographics

  • CLIA Code: 45D2139887
  • Facility Name: WALMART PHARMACY 10-3591
  • Facility Address: 18700 HIGHWAY 105 W
    MONTGOMERY, TX
    ZIP 77356
  • Facility Phone: 936 582-1005
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: YASASWINI BANDLAMUDI
  • NPI Number: 1770501470
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2023
Certificate Expiration Date 11/9/2025
Facility Type Pharmacy
Lab Director YASASWINI BANDLAMUDI

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