11D2119402 CLIA NUMBER - WALMART PHARMACY 10-1293

Laboratory Demographics

  • CLIA Code: 11D2119402
  • Facility Name: WALMART PHARMACY 10-1293
  • Facility Address: 3209 DEANS BRIDGE ROAD
    AUGUSTA, GA
    ZIP 30906
  • Facility Phone: 706 796-7754
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CUONG T. TU
  • NPI Number: 1114944436
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2119402
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1293
Street 3209 DEANS BRIDGE ROAD
City AUGUSTA
State GA
ZIP 30906
Phone 706 796-7754
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Pharmacy
Lab Director CUONG T. TU

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