25D2013344 CLIA NUMBER - WALGREENS #05165

Laboratory Demographics

  • CLIA Code: 25D2013344
  • Facility Name: WALGREENS #05165
  • Facility Address: 204 HIGHWAY 80 EAST
    CLINTON, MS
    ZIP 39056
  • Facility Phone: 601 926-1179
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHUTINUN RUGSACUM
  • NPI Number: 1740295906
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2013344
LAB Type Pharmacy
Facility Name WALGREENS #05165
Street 204 HIGHWAY 80 EAST
City CLINTON
State MS
ZIP 39056
Phone 601 926-1179
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2025
Certificate Expiration Date 10/4/2027
Facility Type Pharmacy
Lab Director CHUTINUN RUGSACUM

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