11D2176194 CLIA NUMBER - WALMART PHARMACY

Laboratory Demographics

  • CLIA Code: 11D2176194
  • Facility Name: WALMART PHARMACY
  • Facility Address: 3886 HIGHWAY 17 S
    EASTANOLLEE, GA
    ZIP 30538
  • Facility Phone: 706 282-1193
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENJAMIN J. UPHOUSE
  • NPI Number: 1720006299
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176194
LAB Type Pharmacy
Facility Name WALMART PHARMACY
Street 3886 HIGHWAY 17 S
City EASTANOLLEE
State GA
ZIP 30538
Phone 706 282-1193
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 BENJAMIN J. UPHOUSE

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