11D2174705 CLIA NUMBER - WALMART PHARMACY 10-3205

Laboratory Demographics

  • CLIA Code: 11D2174705
  • Facility Name: WALMART PHARMACY 10-3205
  • Facility Address: 1100 THORNTON ROAD
    LITHIA SPRINGS, GA
    ZIP 30122
  • Facility Phone: 770 819-0814
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SABA WOLDEGEBRIEL
  • NPI Number: 1730106071
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174705
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3205
Street 1100 THORNTON ROAD
City LITHIA SPRINGS
State GA
ZIP 30122
Phone 770 819-0814
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 SABA WOLDEGEBRIEL

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