25D2014478 CLIA NUMBER - WALGREENS #09402

Laboratory Demographics

  • CLIA Code: 25D2014478
  • Facility Name: WALGREENS #09402
  • Facility Address: 3341 HALLS FERRY ROAD
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 661-9340
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NASTOSHA A. GRIFFIN
  • NPI Number: 1275548430
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2014478
LAB Type Pharmacy
Facility Name WALGREENS #09402
Street 3341 HALLS FERRY ROAD
City VICKSBURG
State MS
ZIP 39180
Phone 601 661-9340
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 NASTOSHA A. GRIFFIN

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