11D2175861 CLIA NUMBER - WALMART PHARMACY 10-1488

Laboratory Demographics

  • CLIA Code: 11D2175861
  • Facility Name: WALMART PHARMACY 10-1488
  • Facility Address: 7001 CONCOURSE PKWY
    DOUGLASVILLE, GA
    ZIP 30134
  • Facility Phone: 770 489-7361
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AYOBAMI KADER
  • NPI Number: 1013934330
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175861
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1488
Street 7001 CONCOURSE PKWY
City DOUGLASVILLE
State GA
ZIP 30134
Phone 770 489-7361
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2023
Certificate Expiration Date 12/2/2025
Facility Type Pharmacy
Lab Director AYOBAMI KADER

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