11D2175992 CLIA NUMBER - WALMART PHARMACY 10-745

Laboratory Demographics

  • CLIA Code: 11D2175992
  • Facility Name: WALMART PHARMACY 10-745
  • Facility Address: 5600 N HENRY BOULEVARD
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 389-4905
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TEQUAWNA KENDRICK-WILLIAMS
  • NPI Number: 1659398063
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2175992
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-745
Street 5600 N HENRY BOULEVARD
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 389-4905
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 TEQUAWNA KENDRICK-WILLIAMS

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This page was last updated on: 3/20/2025