11D2174909 CLIA NUMBER - WALMART PHARMACY 10-3710

Laboratory Demographics

  • CLIA Code: 11D2174909
  • Facility Name: WALMART PHARMACY 10-3710
  • Facility Address: 3580 MEMORIAL DRIVE
    DECATUR, GA
    ZIP 30032
  • Facility Phone: 404 284-0707
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLOTTE CARNEY
  • NPI Number: 1538346580
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174909
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3710
Street 3580 MEMORIAL DRIVE
City DECATUR
State GA
ZIP 30032
Phone 404 284-0707
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 CHARLOTTE CARNEY

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