11D2175222 CLIA NUMBER - WALMART PHARMACY 10-2988

Laboratory Demographics

  • CLIA Code: 11D2175222
  • Facility Name: WALMART PHARMACY 10-2988
  • Facility Address: 2625 NO HIGHWAY 27
    LA FAYETTE, GA
    ZIP 30728
  • Facility Phone: 706 639-4905
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMANUEL THOMPSON
  • NPI Number: 1912924259
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175222
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2988
Street 2625 NO HIGHWAY 27
City LA FAYETTE
State GA
ZIP 30728
Phone 706 639-4905
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 EMANUEL THOMPSON

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