11D2174694 CLIA NUMBER - WALMART PHARMACY 10-3461

Laboratory Demographics

  • CLIA Code: 11D2174694
  • Facility Name: WALMART PHARMACY 10-3461
  • Facility Address: 2717 HIGHWAY 54 WEST
    PEACHTREE CITY, GA
    ZIP 30269
  • Facility Phone: 770 632-6373
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MYIA ELLERBE
  • NPI Number: 1346321775
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 11D2174694
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3461
Street 2717 HIGHWAY 54 WEST
City PEACHTREE CITY
State GA
ZIP 30269
Phone 770 632-6373
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 MYIA ELLERBE

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