11D2174901 CLIA NUMBER - WALMART PHARMACY 10-3748

Laboratory Demographics

  • CLIA Code: 11D2174901
  • Facility Name: WALMART PHARMACY 10-3748
  • Facility Address: 3826 COBB PARKWAY, NW
    ACWORTH, GA
    ZIP 30101
  • Facility Phone: 770 966-1366
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OBINNA N. AGBO
  • NPI Number: 1578653549
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174901
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3748
Street 3826 COBB PARKWAY, NW
City ACWORTH
State GA
ZIP 30101
Phone 770 966-1366
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 OBINNA N. AGBO

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