11D2176647 CLIA NUMBER - WALMART PHARMACY #10-2754

Laboratory Demographics

  • CLIA Code: 11D2176647
  • Facility Name: WALMART PHARMACY #10-2754
  • Facility Address: 1500 N LIBERTY ST
    WAYNESBORO, GA
    ZIP 30830
  • Facility Phone: 706 437-8981
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY J. JACOBS
  • NPI Number: 1275550501
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176647
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2754
Street 1500 N LIBERTY ST
City WAYNESBORO
State GA
ZIP 30830
Phone 706 437-8981
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2023
Certificate Expiration Date 12/18/2025
Facility Type Pharmacy
Lab Director AMY J. JACOBS

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