11D2175319 CLIA NUMBER - WALMART PHARMACY 10-952

Laboratory Demographics

  • CLIA Code: 11D2175319
  • Facility Name: WALMART PHARMACY 10-952
  • Facility Address: 641 VETERANS PARKWAY, S
    MOULTRIE, GA
    ZIP 31788
  • Facility Phone: 229 985-6850
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL R. DIXON
  • NPI Number: 1932126349
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175319
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-952
Street 641 VETERANS PARKWAY, S
City MOULTRIE
State GA
ZIP 31788
Phone 229 985-6850
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 DANIEL R. DIXON

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