11D2175289 CLIA NUMBER - WALMART PHARMACY 10-686

Laboratory Demographics

  • CLIA Code: 11D2175289
  • Facility Name: WALMART PHARMACY 10-686
  • Facility Address: 120 BENJAMIN H HILL DRIVE W
    FITZGERALD, GA
    ZIP 31750
  • Facility Phone: 229 423-5647
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATELIN ETHRIDGE
  • NPI Number: 1851318265
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2175289
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-686
Street 120 BENJAMIN H HILL DRIVE W
City FITZGERALD
State GA
ZIP 31750
Phone 229 423-5647
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 KATELIN ETHRIDGE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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