11D2174900 CLIA NUMBER - WALMART PHARMACY 10-3874

Laboratory Demographics

  • CLIA Code: 11D2174900
  • Facility Name: WALMART PHARMACY 10-3874
  • Facility Address: 98 POWER CENTER DRIVE
    DAWSONVILLE, GA
    ZIP 30534
  • Facility Phone: 706 265-2484
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KASEY G. DILLARD
  • NPI Number: 1265450746
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174900
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3874
Street 98 POWER CENTER DRIVE
City DAWSONVILLE
State GA
ZIP 30534
Phone 706 265-2484
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 KASEY G. DILLARD

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