11D2119487 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-0878

Laboratory Demographics

  • CLIA Code: 11D2119487
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-0878
  • Facility Address: 1500 MARKET PLACE BLVD
    CUMMING, GA
    ZIP 30041
  • Facility Phone: (479) 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM UYEN TRAN THE
  • NPI Number: 1083039572
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 11D2119487
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-0878
Street 1500 MARKET PLACE BLVD
City CUMMING
State GA
ZIP 30041
Phone 4792587034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Pharmacy
Lab Director KIM UYEN TRAN THE

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This page was last updated on: 5/18/2026