11D2174894 CLIA NUMBER - WALMART PHARMACY 10-3750

Laboratory Demographics

  • CLIA Code: 11D2174894
  • Facility Name: WALMART PHARMACY 10-3750
  • Facility Address: 502 BOOTH ROAD
    WARNER ROBINS, GA
    ZIP 31088
  • Facility Phone: 478 918-0678
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEATHER A. FOUNTAIN
  • NPI Number: 1356369839
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174894
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3750
Street 502 BOOTH ROAD
City WARNER ROBINS
State GA
ZIP 31088
Phone 478 918-0678
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Pharmacy
Lab Director HEATHER A. FOUNTAIN

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