11D2175260 CLIA NUMBER - WALMART PHARMACY 10-780

Laboratory Demographics

  • CLIA Code: 11D2175260
  • Facility Name: WALMART PHARMACY 10-780
  • Facility Address: 2050 W SPRING ST
    MONROE, GA
    ZIP 30655
  • Facility Phone: 770 267-4175
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA M. SPORT
  • NPI Number: 1295752525
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175260
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-780
Street 2050 W SPRING ST
City MONROE
State GA
ZIP 30655
Phone 770 267-4175
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Pharmacy
Lab Director ANDREA M. SPORT

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