25D2014165 CLIA NUMBER - WALGREENS #07130

Laboratory Demographics

  • CLIA Code: 25D2014165
  • Facility Name: WALGREENS #07130
  • Facility Address: 6958 GOODMAN ROAD
    OLIVE BRANCH, MS
    ZIP 38654
  • Facility Phone: 662 890-5047
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NATHAN ALLEN
  • NPI Number: 1821003088
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2014165
LAB Type Pharmacy
Facility Name WALGREENS #07130
Street 6958 GOODMAN ROAD
City OLIVE BRANCH
State MS
ZIP 38654
Phone 662 890-5047
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director NATHAN ALLEN

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