11D2174428 CLIA NUMBER - WALMART- PHARMACY 10-5151

Laboratory Demographics

  • CLIA Code: 11D2174428
  • Facility Name: WALMART- PHARMACY 10-5151
  • Facility Address: 825 CARTERSVILLE HIGHWAY SE
    ROME, GA
    ZIP 30161
  • Facility Phone: 706 292-9206
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSELYN GIFFORD
  • NPI Number: 1801813142
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174428
LAB Type Pharmacy
Facility Name WALMART- PHARMACY 10-5151
Street 825 CARTERSVILLE HIGHWAY SE
City ROME
State GA
ZIP 30161
Phone 706 292-9206
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2023
Certificate Expiration Date 10/30/2025
Facility Type Pharmacy
Lab Director JESSELYN GIFFORD

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