25D2011303 CLIA NUMBER - WALGREENS #06771

Laboratory Demographics

  • CLIA Code: 25D2011303
  • Facility Name: WALGREENS #06771
  • Facility Address: 817 W MAIN STREET
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 662 620-7959
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARCUS B. BURCHAM
  • NPI Number: 1003821265
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2011303
LAB Type Pharmacy
Facility Name WALGREENS #06771
Street 817 W MAIN STREET
City TUPELO
State MS
ZIP 38801
Phone 662 620-7959
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Pharmacy
Lab Director MARCUS B. BURCHAM

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