11D2175437 CLIA NUMBER - WALMART PHARMACY 10-2584

Laboratory Demographics

  • CLIA Code: 11D2175437
  • Facility Name: WALMART PHARMACY 10-2584
  • Facility Address: 4375 LAWRENCEVILLE HIGHWAY
    TUCKER, GA
    ZIP 30084
  • Facility Phone: 770 939-9278
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MANDANA MANOUCHEHRI
  • NPI Number: 1720005051
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175437
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2584
Street 4375 LAWRENCEVILLE HIGHWAY
City TUCKER
State GA
ZIP 30084
Phone 770 939-9278
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 MANDANA MANOUCHEHRI

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