45D2150876 CLIA NUMBER - WALMART PHARMACY 10-4508

Laboratory Demographics

  • CLIA Code: 45D2150876
  • Facility Name: WALMART PHARMACY 10-4508
  • Facility Address: 1705 EXRESSWAY 83
    PENITAS, TX
    ZIP 78576
  • Facility Phone: 956 580-1511
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA M. FREDERICKS
  • NPI Number: 1053551598
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2150876
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4508
Street 1705 EXRESSWAY 83
City PENITAS
State TX
ZIP 78576
Phone 956 580-1511
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Pharmacy
Lab Director MELISSA M. FREDERICKS

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