11D2175435 CLIA NUMBER - WALMART PHARMACY 10-1458

Laboratory Demographics

  • CLIA Code: 11D2175435
  • Facility Name: WALMART PHARMACY 10-1458
  • Facility Address: 3040 BATTLEFIELD PARKWAY
    FORT OGLETHORPE, GA
    ZIP 30742
  • Facility Phone: 706 861-6252
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY TRAVIS
  • NPI Number: 1659398972
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175435
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1458
Street 3040 BATTLEFIELD PARKWAY
City FORT OGLETHORPE
State GA
ZIP 30742
Phone 706 861-6252
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 ANTHONY TRAVIS

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