11D2174819 CLIA NUMBER - WALMART PHARMACY 10-3067

Laboratory Demographics

  • CLIA Code: 11D2174819
  • Facility Name: WALMART PHARMACY 10-3067
  • Facility Address: 4975 JIMMY CARTER BOULEVARD
    NORCROSS, GA
    ZIP 30093
  • Facility Phone: 770 225-9906
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SADIK HUSSEN
  • NPI Number: 1184062846
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174819
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3067
Street 4975 JIMMY CARTER BOULEVARD
City NORCROSS
State GA
ZIP 30093
Phone 770 225-9906
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 SADIK HUSSEN

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