11D2174710 CLIA NUMBER - WALMART PHARMACY 10-3570

Laboratory Demographics

  • CLIA Code: 11D2174710
  • Facility Name: WALMART PHARMACY 10-3570
  • Facility Address: 4469 WASHINGTON ROAD
    EVANS, GA
    ZIP 30809
  • Facility Phone: 706 854-1516
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN PUGH
  • NPI Number: 1376560615
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174710
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3570
Street 4469 WASHINGTON ROAD
City EVANS
State GA
ZIP 30809
Phone 706 854-1516
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 RYAN PUGH

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