11D2175314 CLIA NUMBER - WALMART PHARMACY 10-889

Laboratory Demographics

  • CLIA Code: 11D2175314
  • Facility Name: WALMART PHARMACY 10-889
  • Facility Address: 15328 US HIGHWAY 19 S
    THOMASVILLE, GA
    ZIP 31757
  • Facility Phone: 229 228-5771
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEE B. SHIVER
  • NPI Number: 1114944527
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175314
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-889
Street 15328 US HIGHWAY 19 S
City THOMASVILLE
State GA
ZIP 31757
Phone 229 228-5771
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 ASHLEE B. SHIVER

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