25D2020811 CLIA NUMBER - WALGREENS #05655

Laboratory Demographics

  • CLIA Code: 25D2020811
  • Facility Name: WALGREENS #05655
  • Facility Address: 6970 OLD CANTON ROAD
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 601 956-3844
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT RUSHING
  • NPI Number: 1194730358
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2020811
LAB Type Pharmacy
Facility Name WALGREENS #05655
Street 6970 OLD CANTON ROAD
City RIDGELAND
State MS
ZIP 39157
Phone 601 956-3844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director ROBERT RUSHING

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