25D2011846 CLIA NUMBER - WALGREENS #05195

Laboratory Demographics

  • CLIA Code: 25D2011846
  • Facility Name: WALGREENS #05195
  • Facility Address: 15371 DEDEAUX ROAD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 539-9890
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER T. HOPWOOD
  • NPI Number: 1477568632
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2011846
LAB Type Pharmacy
Facility Name WALGREENS #05195
Street 15371 DEDEAUX ROAD
City GULFPORT
State MS
ZIP 39503
Phone 228 539-9890
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/15/2025
Certificate Expiration Date 10/14/2027
Facility Type Pharmacy
Lab Director JENNIFER T. HOPWOOD

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