11D2175766 CLIA NUMBER - WALMART PHARMACY 10-3401

Laboratory Demographics

  • CLIA Code: 11D2175766
  • Facility Name: WALMART PHARMACY 10-3401
  • Facility Address: 6149 OLD NATIONAL HIGHWAY
    COLLEGE PARK, GA
    ZIP 30349
  • Facility Phone: 770 994-0199
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAENNE ORUNOLA
  • NPI Number: 1922163138
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175766
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3401
Street 6149 OLD NATIONAL HIGHWAY
City COLLEGE PARK
State GA
ZIP 30349
Phone 770 994-0199
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 MAENNE ORUNOLA

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