45D2142223 CLIA NUMBER - WALMART PHARMACY 10-0572

Laboratory Demographics

  • CLIA Code: 45D2142223
  • Facility Name: WALMART PHARMACY 10-0572
  • Facility Address: 1201 STONE ST
    KILGORE, TX
    ZIP 75662
  • Facility Phone: 903 983-1056
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SAMMY P. REDDEN
  • NPI Number: 1497773261
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2142223
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0572
Street 1201 STONE ST
City KILGORE
State TX
ZIP 75662
Phone 903 983-1056
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2024
Certificate Expiration Date 1/7/2026
Facility Type Pharmacy
Lab Director SAMMY P. REDDEN

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