11D2175315 CLIA NUMBER - WALMART PHARMACY 10-615

Laboratory Demographics

  • CLIA Code: 11D2175315
  • Facility Name: WALMART PHARMACY 10-615
  • Facility Address: 101 MARKET PLACE BOULEVARD
    CARTERSVILLE, GA
    ZIP 30121
  • Facility Phone: 770 386-7582
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MANDA BASS
  • NPI Number: 1669499083
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175315
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-615
Street 101 MARKET PLACE BOULEVARD
City CARTERSVILLE
State GA
ZIP 30121
Phone 770 386-7582
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 MANDA BASS

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