11D2176192 CLIA NUMBER - WALMART PHARMACY 10-494

Laboratory Demographics

  • CLIA Code: 11D2176192
  • Facility Name: WALMART PHARMACY 10-494
  • Facility Address: 1025 HIGHWAY 34 E
    NEWNAN, GA
    ZIP 30265
  • Facility Phone: 770 254-9765
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAITLYN A. HELLAM
  • NPI Number: 1295752616
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176192
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-494
Street 1025 HIGHWAY 34 E
City NEWNAN
State GA
ZIP 30265
Phone 770 254-9765
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 KAITLYN A. HELLAM

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