11D2175786 CLIA NUMBER - WALMART PHARMACY 10-3627

Laboratory Demographics

  • CLIA Code: 11D2175786
  • Facility Name: WALMART PHARMACY 10-3627
  • Facility Address: 3875 MUNDY MILL ROAD
    OAKWOOD, GA
    ZIP 30566
  • Facility Phone: 770 535-3702
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TANIKA A. LAWRENCE
  • NPI Number: 1518184597
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175786
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3627
Street 3875 MUNDY MILL ROAD
City OAKWOOD
State GA
ZIP 30566
Phone 770 535-3702
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 TANIKA A. LAWRENCE

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