11D2174686 CLIA NUMBER - WALMART PHARMACY 10-6732

Laboratory Demographics

  • CLIA Code: 11D2174686
  • Facility Name: WALMART PHARMACY 10-6732
  • Facility Address: 4196 BEMISS ROAD
    VALDOSTA, GA
    ZIP 31601
  • Facility Phone: 229 588-7577
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUSANNA GODWIN
  • NPI Number: 1760938013
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174686
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-6732
Street 4196 BEMISS ROAD
City VALDOSTA
State GA
ZIP 31601
Phone 229 588-7577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Pharmacy
Lab Director SUSANNA GODWIN

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