11D2176648 CLIA NUMBER - WALMART PHARMACY 10-2858

Laboratory Demographics

  • CLIA Code: 11D2176648
  • Facility Name: WALMART PHARMACY 10-2858
  • Facility Address: 349 BRAMPTON AVENUE
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 489-4643
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARY RODNICKI
  • NPI Number: 1588063911
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176648
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2858
Street 349 BRAMPTON AVENUE
City STATESBORO
State GA
ZIP 30458
Phone 912 489-4643
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 MARY RODNICKI

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