11D2175207 CLIA NUMBER - WALMART PHARMACY 10-1006

Laboratory Demographics

  • CLIA Code: 11D2175207
  • Facility Name: WALMART PHARMACY 10-1006
  • Facility Address: 1215 E 16TH AVENUE
    CORDELE, GA
    ZIP 31015
  • Facility Phone: 229 273-9390
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FALAN C. JOHNSON
  • NPI Number: 1750308169
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175207
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1006
Street 1215 E 16TH AVENUE
City CORDELE
State GA
ZIP 31015
Phone 229 273-9390
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Pharmacy
Lab Director FALAN C. JOHNSON

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