11D2175421 CLIA NUMBER - WALMART PHARMACY 10-1072

Laboratory Demographics

  • CLIA Code: 11D2175421
  • Facility Name: WALMART PHARMACY 10-1072
  • Facility Address: 1830 US HIGHWAY 82 W
    TIFTON, GA
    ZIP 31793
  • Facility Phone: 229 386-0374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACOB SAULS
  • NPI Number: 1578580981
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175421
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1072
Street 1830 US HIGHWAY 82 W
City TIFTON
State GA
ZIP 31793
Phone 229 386-0374
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 JACOB SAULS

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