11D2174689 CLIA NUMBER - WALMART PHARMACY 10-5392

Laboratory Demographics

  • CLIA Code: 11D2174689
  • Facility Name: WALMART PHARMACY 10-5392
  • Facility Address: 980 W PARKER STREET
    BAXLEY, GA
    ZIP 31513
  • Facility Phone: 912 367-3234
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARLIS M. HAND JR
  • NPI Number: 1447277785
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174689
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5392
Street 980 W PARKER STREET
City BAXLEY
State GA
ZIP 31513
Phone 912 367-3234
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 CARLIS M. HAND JR

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