11D2176214 CLIA NUMBER - WALMART PHARMACY 10-5173

Laboratory Demographics

  • CLIA Code: 11D2176214
  • Facility Name: WALMART PHARMACY 10-5173
  • Facility Address: 815 SHUGART ROAD
    DALTON, GA
    ZIP 30720
  • Facility Phone: 706 271-2834
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSH FOWLER
  • NPI Number: 1275550519
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176214
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5173
Street 815 SHUGART ROAD
City DALTON
State GA
ZIP 30720
Phone 706 271-2834
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 JOSH FOWLER

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