11D2174693 CLIA NUMBER - WALMART PHARMACY 10-5812

Laboratory Demographics

  • CLIA Code: 11D2174693
  • Facility Name: WALMART PHARMACY 10-5812
  • Facility Address: 97 COMMERCE DRIVE
    BLUE RIDGE, GA
    ZIP 30513
  • Facility Phone: 706 632-9508
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL T. PHILLIPS
  • NPI Number: 1619391372
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174693
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5812
Street 97 COMMERCE DRIVE
City BLUE RIDGE
State GA
ZIP 30513
Phone 706 632-9508
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 MICHAEL T. PHILLIPS

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