11D2176880 CLIA NUMBER - WALMART PHARMACY 10-594

Laboratory Demographics

  • CLIA Code: 11D2176880
  • Facility Name: WALMART PHARMACY 10-594
  • Facility Address: 125 PAVILION PARKWAY
    FAYETTEVILLE, GA
    ZIP 30214
  • Facility Phone: 770 460-0726
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NINA CHUKWURA
  • NPI Number: 1922025337
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176880
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-594
Street 125 PAVILION PARKWAY
City FAYETTEVILLE
State GA
ZIP 30214
Phone 770 460-0726
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2023
Certificate Expiration Date 12/29/2025
Facility Type Pharmacy
Lab Director NINA CHUKWURA

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