11D2175424 CLIA NUMBER - WALMART PHARMACY 10-1112

Laboratory Demographics

CLIA Number: 11D2175424

Facility Name: WALMART PHARMACY 10-1112

Facility Address:
855 NORTH CHURCH STREET
THOMASTON, GA
ZIP 30286
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Facility Phone Number: 706 648-2109

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1487671897

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2175424
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-1112
Street	855 NORTH CHURCH STREET
City	THOMASTON
State	GA
ZIP	30286
Phone	706 648-2109
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