11D2174717 CLIA NUMBER - WALMART PHARMACY 10-4409

Laboratory Demographics

  • CLIA Code: 11D2174717
  • Facility Name: WALMART PHARMACY 10-4409
  • Facility Address: 1801 NATHAN DEAN BYPASS
    ROCKMART, GA
    ZIP 30153
  • Facility Phone: 678 757-9756
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CASSIE CALLAN
  • NPI Number: 1194926642
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174717
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4409
Street 1801 NATHAN DEAN BYPASS
City ROCKMART
State GA
ZIP 30153
Phone 678 757-9756
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 CASSIE CALLAN

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