11D2176179 CLIA NUMBER - WALMART PHARMACY 10-1701

Laboratory Demographics

  • CLIA Code: 11D2176179
  • Facility Name: WALMART PHARMACY 10-1701
  • Facility Address: 955 ELBERT STREET
    ELBERTON, GA
    ZIP 30635
  • Facility Phone: 706 283-8735
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDY THOMAS
  • NPI Number: 1194742411
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176179
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1701
Street 955 ELBERT STREET
City ELBERTON
State GA
ZIP 30635
Phone 706 283-8735
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2023
Certificate Expiration Date 12/9/2025
Facility Type Pharmacy
Lab Director BRANDY THOMAS

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