11D2176645 CLIA NUMBER - WALMART PHARMACY 10-2732

Laboratory Demographics

  • CLIA Code: 11D2176645
  • Facility Name: WALMART PHARMACY 10-2732
  • Facility Address: 600 CARROLLTON VILLA RICA HWY
    VILLA RICA, GA
    ZIP 30180
  • Facility Phone: (770) 459-9117
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BETSY E. MCCOWEN
  • NPI Number: 1184641417
  • Taxonomy: 3336C0003X - Pharmacy

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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 7704599117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2025
Certificate Expiration Date 12/18/2027
Facility Type Pharmacy
Lab Director BETSY E. MCCOWEN

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This page was last updated on: 5/18/2026