25D2013342 CLIA NUMBER - WALGREENS #05791

Laboratory Demographics

  • CLIA Code: 25D2013342
  • Facility Name: WALGREENS #05791
  • Facility Address: 1497 CANTON MART ROAD
    JACKSON, MS
    ZIP 39211
  • Facility Phone: 601 956-2421
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: D ANDREA LLOYD
  • NPI Number: 1154337624
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2013342
LAB Type Pharmacy
Facility Name WALGREENS #05791
Street 1497 CANTON MART ROAD
City JACKSON
State MS
ZIP 39211
Phone 601 956-2421
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Pharmacy
Lab Director D ANDREA LLOYD

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