11D2174699 CLIA NUMBER - WALMART PHARMACY 10-3402

Laboratory Demographics

  • CLIA Code: 11D2174699
  • Facility Name: WALMART PHARMACY 10-3402
  • Facility Address: 1400 HUDSON BRIDGE ROAD
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 474-0454
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT BRADY
  • NPI Number: 1700970860
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2174699
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3402
Street 1400 HUDSON BRIDGE ROAD
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 474-0454
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 ROBERT BRADY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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