11D2175395 CLIA NUMBER - WALMART PHARMACY 10-1070

Laboratory Demographics

  • CLIA Code: 11D2175395
  • Facility Name: WALMART PHARMACY 10-1070
  • Facility Address: 88 HIGHLAND XING
    ELLIJAY, GA
    ZIP 30540
  • Facility Phone: 706 276-1180
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAIME ERWIN
  • NPI Number: 1629480298
  • Taxonomy: 261QC1500X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2175395
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1070
Street 88 HIGHLAND XING
City ELLIJAY
State GA
ZIP 30540
Phone 706 276-1180
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Pharmacy
Lab Director JAIME ERWIN

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