11D2176680 CLIA NUMBER - WALMART PHARMACY 10-3388

Laboratory Demographics

  • CLIA Code: 11D2176680
  • Facility Name: WALMART PHARMACY 10-3388
  • Facility Address: 1400 LAWRENCEVILLE HWY
    LAWRENCEVILLE, GA
    ZIP 30044
  • Facility Phone: 770 682-5342
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLY TA
  • NPI Number: 1265459507
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176680
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3388
Street 1400 LAWRENCEVILLE HWY
City LAWRENCEVILLE
State GA
ZIP 30044
Phone 770 682-5342
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 KELLY TA

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