11D2175436 CLIA NUMBER - WALMART PHARMACY 10-1658

Laboratory Demographics

  • CLIA Code: 11D2175436
  • Facility Name: WALMART PHARMACY 10-1658
  • Facility Address: 2205 HARRISON ROAD, SE
    THOMSON, GA
    ZIP 30824
  • Facility Phone: 706 595-0180
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EBENEZER NANA DUODU
  • NPI Number: 1477570794
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175436
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1658
Street 2205 HARRISON ROAD, SE
City THOMSON
State GA
ZIP 30824
Phone 706 595-0180
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 EBENEZER NANA DUODU

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