11D2175395 CLIA NUMBER - WALMART PHARMACY 10-1070

Laboratory Demographics

CLIA Number: 11D2175395

Facility Name: WALMART PHARMACY 10-1070

Facility Address:
88 HIGHLAND XING
ELLIJAY, GA
ZIP 30540
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Facility Phone Number: 706 276-1180

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1629480298

Taxonomy: 261QC1500X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024