11D2175299 CLIA NUMBER - WALMART PHARMACY 10-727

Laboratory Demographics

  • CLIA Code: 11D2175299
  • Facility Name: WALMART PHARMACY 10-727
  • Facility Address: 1585 ROME HIGHWAY
    CEDARTOWN, GA
    ZIP 30125
  • Facility Phone: 770 748-2264
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARIS RUDESEAL
  • NPI Number: 1295752517
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175299
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-727
Street 1585 ROME HIGHWAY
City CEDARTOWN
State GA
ZIP 30125
Phone 770 748-2264
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 CHARIS RUDESEAL

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