11D2177004 CLIA NUMBER - WALMART PHARMACY 10-1363

Laboratory Demographics

  • CLIA Code: 11D2177004
  • Facility Name: WALMART PHARMACY 10-1363
  • Facility Address: 1681 EATONTON ROAD
    MADISON, GA
    ZIP 30650
  • Facility Phone: 706 342-4853
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REBEKAH SOTO
  • NPI Number: 1487671707
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 11D2177004
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1363
Street 1681 EATONTON ROAD
City MADISON
State GA
ZIP 30650
Phone 706 342-4853
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2024
Certificate Expiration Date 1/1/2026
Facility Type Pharmacy
Lab Director REBEKAH SOTO

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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