25D2020811 CLIA NUMBER - WALGREENS #05655

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Laboratory Demographics

CLIA Number: 25D2020811

Facility Name: WALGREENS #05655

Facility Address:
6970 OLD CANTON ROAD
RIDGELAND, MS
ZIP 39157
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Facility Phone Number: 601 956-3844

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1194730358

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

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
CertificateType	4
CertificateEffectiveDate	3/22/2023
CertificateExpirationDate	3/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024