11D2174816 CLIA NUMBER - WALMART PHARMACY 10-4527

Laboratory Demographics

  • CLIA Code: 11D2174816
  • Facility Name: WALMART PHARMACY 10-4527
  • Facility Address: 1630 PLANT AVE
    WAYCROSS, GA
    ZIP 31501
  • Facility Phone: 912 584-6084
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN THOMAS
  • NPI Number: 1770965634
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174816
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4527
Street 1630 PLANT AVE
City WAYCROSS
State GA
ZIP 31501
Phone 912 584-6084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director STEPHEN THOMAS

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