11D2175609 CLIA NUMBER - WALMART PHARMACY 10-518

Laboratory Demographics

  • CLIA Code: 11D2175609
  • Facility Name: WALMART PHARMACY 10-518
  • Facility Address: 1550 RIVERSTONE PKWY
    CANTON, GA
    ZIP 30114
  • Facility Phone: 770 479-9003
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM UYEN TRAN-THE
  • NPI Number: 1457379927
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2175609
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-518
Street 1550 RIVERSTONE PKWY
City CANTON
State GA
ZIP 30114
Phone 770 479-9003
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 KIM UYEN TRAN-THE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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