11D2176897 CLIA NUMBER - WALMART PHARMACY 10-3471

Laboratory Demographics

  • CLIA Code: 11D2176897
  • Facility Name: WALMART PHARMACY 10-3471
  • Facility Address: 3105 COBB PARKWAY, NW
    KENNESAW, GA
    ZIP 30152
  • Facility Phone: 770 974-5119
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACY SHOEMAKE PARK
  • NPI Number: 1649298126
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2176897
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3471
Street 3105 COBB PARKWAY, NW
City KENNESAW
State GA
ZIP 30152
Phone 770 974-5119
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 STACY SHOEMAKE PARK

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