11D2175604 CLIA NUMBER - WALMART PHARMACY 10-639

Laboratory Demographics

  • CLIA Code: 11D2175604
  • Facility Name: WALMART PHARMACY 10-639
  • Facility Address: 150 ALTAMA CONNECTOR
    BRUNSWICK, GA
    ZIP 31525
  • Facility Phone: 912 261-0553
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRUDY KELLY
  • NPI Number: 1922025253
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175604
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-639
Street 150 ALTAMA CONNECTOR
City BRUNSWICK
State GA
ZIP 31525
Phone 912 261-0553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/25/2023
Certificate Expiration Date 11/24/2025
Facility Type Pharmacy
Lab Director TRUDY KELLY

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