25D1088225 CLIA NUMBER - SUMRALL DRUG STORE LLC

Laboratory Demographics

  • CLIA Code: 25D1088225
  • Facility Name: SUMRALL DRUG STORE LLC
  • Facility Address: 1109 HIGHWAY 42
    SUMRALL, MS
    ZIP 39482
  • Facility Phone: 601 758-4243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TASHA F. HADEN
  • NPI Number: 1275613952
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D1088225
LAB Type Pharmacy
Facility Name SUMRALL DRUG STORE LLC
Street 1109 HIGHWAY 42
City SUMRALL
State MS
ZIP 39482
Phone 601 758-4243
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2024
Certificate Expiration Date 6/1/2026
Facility Type Pharmacy
Lab Director TASHA F. HADEN

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