11D2176691 CLIA NUMBER - WALMART PHARMACY 10-1373

Laboratory Demographics

  • CLIA Code: 11D2176691
  • Facility Name: WALMART PHARMACY 10-1373
  • Facility Address: 4004 LAWRENCEVILLE HIGHWAY NW
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 770 921-0228
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIN YEONG KIM
  • NPI Number: 1104843424
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176691
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1373
Street 4004 LAWRENCEVILLE HIGHWAY NW
City LILBURN
State GA
ZIP 30047
Phone 770 921-0228
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 SIN YEONG KIM

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