11D2175208 CLIA NUMBER - WALMART PHARMACY 10-2753

Laboratory Demographics

  • CLIA Code: 11D2175208
  • Facility Name: WALMART PHARMACY 10-2753
  • Facility Address: 1455 HIGHWAY 441 SOUTH
    CLAYTON, GA
    ZIP 30525
  • Facility Phone: 706 782-3730
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIELLE M. WASHAM
  • NPI Number: 1194742437
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175208
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2753
Street 1455 HIGHWAY 441 SOUTH
City CLAYTON
State GA
ZIP 30525
Phone 706 782-3730
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 DANIELLE M. WASHAM

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