11D2119580 CLIA NUMBER - WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3462

Laboratory Demographics

  • CLIA Code: 11D2119580
  • Facility Name: WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3462
  • Facility Address: 3245 LAWRENCEVILLE SUWANEE ROAD
    SUWANEE, GA
    ZIP 30024
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RACHEL LIBOWSKY
  • NPI Number: 1902823248
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2119580
LAB Type Pharmacy
Facility Name WAL-MART STORES EAST, LP DBA WAL-MART PHARMACY #10-3462
Street 3245 LAWRENCEVILLE SUWANEE ROAD
City SUWANEE
State GA
ZIP 30024
Phone 479 258-7034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/29/2024
Certificate Expiration Date 9/28/2026
Facility Type Pharmacy
Lab Director RACHEL LIBOWSKY

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