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11D2175285 CLIA NUMBER - WALMART PHARMACY 10-658

Laboratory Demographics

CLIA Number: 11D2175285

Facility Name: WALMART PHARMACY 10-658

Facility Address:
2510 REDMOND CIRCLE NW
ROME, GA
ZIP 30165
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Facility Phone Number: 706 235-3699

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1740207067

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 11D2175285
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-658
Street 2510 REDMOND CIRCLE NW
City ROME
State GA
ZIP 30165
Phone 706 235-3699
CertificateType 4
CertificateEffectiveDate 11/19/2023
CertificateExpirationDate 11/18/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024