11D2174911 CLIA NUMBER - WALMART PHARMACY 10-3741

Laboratory Demographics

  • CLIA Code: 11D2174911
  • Facility Name: WALMART PHARMACY 10-3741
  • Facility Address: 1105 RESEARCH CENTER ATLANTA DRIVE, SW
    ATLANTA, GA
    ZIP 30331
  • Facility Phone: 404 260-7779
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEX J. PERRYMAN
  • NPI Number: 1952743445
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2174911
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3741
Street 1105 RESEARCH CENTER ATLANTA DRIVE, SW
City ATLANTA
State GA
ZIP 30331
Phone 404 260-7779
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 ALEX J. PERRYMAN

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