11D2174916 CLIA NUMBER - WALMART PHARMACY 10-3621

Laboratory Demographics

  • CLIA Code: 11D2174916
  • Facility Name: WALMART PHARMACY 10-3621
  • Facility Address: 1871 CHAMBLEE TUCKER ROAD
    CHAMBLEE, GA
    ZIP 30341
  • Facility Phone: 770 455-4699
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AZAVI PANTEHA MORT
  • NPI Number: 1659436863
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2174916
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3621
Street 1871 CHAMBLEE TUCKER ROAD
City CHAMBLEE
State GA
ZIP 30341
Phone 770 455-4699
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 AZAVI PANTEHA MORT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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