11D2175764 CLIA NUMBER - WALMART PHARMACY 10-856

Laboratory Demographics

  • CLIA Code: 11D2175764
  • Facility Name: WALMART PHARMACY 10-856
  • Facility Address: 404 HIGHWAY 27 NO BYPASS
    BREMEN, GA
    ZIP 30110
  • Facility Phone: 770 537-2131
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LATRISA M. MASON
  • NPI Number: 1639197106
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175764
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-856
Street 404 HIGHWAY 27 NO BYPASS
City BREMEN
State GA
ZIP 30110
Phone 770 537-2131
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Pharmacy
Lab Director LATRISA M. MASON

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