11D2175790 CLIA NUMBER - WALMART PHARMACY 10-4616

Laboratory Demographics

  • CLIA Code: 11D2175790
  • Facility Name: WALMART PHARMACY 10-4616
  • Facility Address: 260 DONALD E THURMOND PARKWAY
    CLEVELAND, GA
    ZIP 30528
  • Facility Phone: 706 219-2309
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COREY BIRD
  • NPI Number: 1740415835
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175790
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4616
Street 260 DONALD E THURMOND PARKWAY
City CLEVELAND
State GA
ZIP 30528
Phone 706 219-2309
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 COREY BIRD

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