11D2175219 CLIA NUMBER - WALMART PHARMACY 10-2890

Laboratory Demographics

  • CLIA Code: 11D2175219
  • Facility Name: WALMART PHARMACY 10-2890
  • Facility Address: 5955 ZEBULON ROAD
    MACON, GA
    ZIP 31210
  • Facility Phone: 478 471-9122
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASMINE GRAPER
  • NPI Number: 1184641425
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175219
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2890
Street 5955 ZEBULON ROAD
City MACON
State GA
ZIP 31210
Phone 478 471-9122
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 JASMINE GRAPER

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