11D2175985 CLIA NUMBER - WALMART PHARMACY 10-899

Laboratory Demographics

  • CLIA Code: 11D2175985
  • Facility Name: WALMART PHARMACY 10-899
  • Facility Address: 340 NORMAN DRIVE
    VALDOSTA, GA
    ZIP 31601
  • Facility Phone: 229 244-6188
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK BUKARI
  • NPI Number: 1023035433
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175985
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-899
Street 340 NORMAN DRIVE
City VALDOSTA
State GA
ZIP 31601
Phone 229 244-6188
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/5/2023
Certificate Expiration Date 12/4/2025
Facility Type Pharmacy
Lab Director MARK BUKARI

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