11D2176217 CLIA NUMBER - WALMART PHARMACY 10-5363

Laboratory Demographics

  • CLIA Code: 11D2176217
  • Facility Name: WALMART PHARMACY 10-5363
  • Facility Address: 11465 TARA BLVD
    LOVEJOY, GA
    ZIP 30250
  • Facility Phone: 770 471-5055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLUBUNMI ADENIYI
  • NPI Number: 1558389031
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176217
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5363
Street 11465 TARA BLVD
City LOVEJOY
State GA
ZIP 30250
Phone 770 471-5055
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 OLUBUNMI ADENIYI

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