11D2176673 CLIA NUMBER - WALMART PHARMACY 10-5709

Laboratory Demographics

  • CLIA Code: 11D2176673
  • Facility Name: WALMART PHARMACY 10-5709
  • Facility Address: 4949 BILL GARDNER PKWY
    LOCUST GROVE, GA
    ZIP 30248
  • Facility Phone: 678 734-3492
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KERI D. TAYLOR
  • NPI Number: 1659675817
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176673
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5709
Street 4949 BILL GARDNER PKWY
City LOCUST GROVE
State GA
ZIP 30248
Phone 678 734-3492
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Pharmacy
Lab Director KERI D. TAYLOR

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