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11D2176645 CLIA NUMBER - WALMART PHARMACY 10-2732

Laboratory Demographics

CLIA Number: 11D2176645

Facility Name: WALMART PHARMACY 10-2732

Facility Address:
600 CARROLLTON VILLA RICA HWY
VILLA RICA, GA
ZIP 30180
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Facility Phone Number: 770 459-9117

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1184641417

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 11D2176645
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2732
Street 600 CARROLLTON VILLA RICA HWY
City VILLA RICA
State GA
ZIP 30180
Phone 770 459-9117
CertificateType 4
CertificateEffectiveDate 12/19/2023
CertificateExpirationDate 12/18/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024