11D2176199 CLIA NUMBER - WALMART PHARMACY 10-1143

Laboratory Demographics

  • CLIA Code: 11D2176199
  • Facility Name: WALMART PHARMACY 10-1143
  • Facility Address: 1308 S HARRIS STREET
    SANDERSVILLE, GA
    ZIP 31082
  • Facility Phone: 478 552-7063
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHILLIP E. SULTER
  • NPI Number: 1013934439
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176199
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1143
Street 1308 S HARRIS STREET
City SANDERSVILLE
State GA
ZIP 31082
Phone 478 552-7063
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 PHILLIP E. SULTER

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