11D2174712 CLIA NUMBER - WALMART PHARMACY 10-4200

Laboratory Demographics

  • CLIA Code: 11D2174712
  • Facility Name: WALMART PHARMACY 10-4200
  • Facility Address: 6475 GATEWAY ROAD
    COLUMBUS, GA
    ZIP 31909
  • Facility Phone: 706 563-6535
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CANDICE N. HARDEMAN
  • NPI Number: 1699953059
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174712
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4200
Street 6475 GATEWAY ROAD
City COLUMBUS
State GA
ZIP 31909
Phone 706 563-6535
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 CANDICE N. HARDEMAN

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