11D2176681 CLIA NUMBER - WALMART PHARMACY 10-3118

Laboratory Demographics

CLIA Number: 11D2176681

Facility Name: WALMART PHARMACY 10-3118

Facility Address:
2525 N DECATUR ROAD
DECATUR, GA
ZIP 30033
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Facility Phone Number: 404 464-4475

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1912375809

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	11D2176681
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-3118
Street	2525 N DECATUR ROAD
City	DECATUR
State	GA
ZIP	30033
Phone	404 464-4475
CertificateType	4
CertificateEffectiveDate	12/20/2023
CertificateExpirationDate	12/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024