11D2200171 CLIA NUMBER - BAXLEY WELLNESS PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 11D2200171
  • Facility Name: BAXLEY WELLNESS PHARMACY, INC
  • Facility Address: 160 AZALEA ROAD
    BAXLEY, GA
    ZIP 31513
  • Facility Phone: 912 245-4270
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIANA B. AYCOCK
  • NPI Number: 1205438330
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2200171
LAB Type Pharmacy
Facility Name BAXLEY WELLNESS PHARMACY, INC
Street 160 AZALEA ROAD
City BAXLEY
State GA
ZIP 31513
Phone 912 245-4270
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/13/2024
Certificate Expiration Date 11/12/2026
Facility Type Pharmacy
Lab Director BRIANA B. AYCOCK

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