11D2177995 CLIA NUMBER - WALMART PHARMACY 10-459

Laboratory Demographics

  • CLIA Code: 11D2177995
  • Facility Name: WALMART PHARMACY 10-459
  • Facility Address: 10300 INDUSTRIAL BOULEVARD, NE
    COVINGTON, GA
    ZIP 30014
  • Facility Phone: 770 787-8164
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALI FLEURANCIA
  • NPI Number: 1205853520
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2177995
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-459
Street 10300 INDUSTRIAL BOULEVARD, NE
City COVINGTON
State GA
ZIP 30014
Phone 770 787-8164
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2024
Certificate Expiration Date 1/22/2026
Facility Type Pharmacy
Lab Director ALI FLEURANCIA

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