11D2174826 CLIA NUMBER - WALMART PHARMACY 10-3188

Laboratory Demographics

  • CLIA Code: 11D2174826
  • Facility Name: WALMART PHARMACY 10-3188
  • Facility Address: 5935 MEMORIAL DRIVE
    STONE MOUNTAIN, GA
    ZIP 30083
  • Facility Phone: 404 260-6149
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFERY FELTON
  • NPI Number: 1053755314
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174826
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3188
Street 5935 MEMORIAL DRIVE
City STONE MOUNTAIN
State GA
ZIP 30083
Phone 404 260-6149
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 JEFFERY FELTON

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