11D2175990 CLIA NUMBER - WALMART PHARMACY 10-520

Laboratory Demographics

  • CLIA Code: 11D2175990
  • Facility Name: WALMART PHARMACY 10-520
  • Facility Address: 440 ATLANTA HIGHWAY, NW
    WINDER, GA
    ZIP 30680
  • Facility Phone: 770 307-1272
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEIGH J. BENTON
  • NPI Number: 1821015140
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175990
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-520
Street 440 ATLANTA HIGHWAY, NW
City WINDER
State GA
ZIP 30680
Phone 770 307-1272
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 ASHLEIGH J. BENTON

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