25D2026738 CLIA NUMBER - WALGREENS #09013

Laboratory Demographics

  • CLIA Code: 25D2026738
  • Facility Name: WALGREENS #09013
  • Facility Address: 1065 MAIN ST
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 393-8527
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANGELA G. FOSHEE
  • NPI Number: 1972519445
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2026738
LAB Type Pharmacy
Facility Name WALGREENS #09013
Street 1065 MAIN ST
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 393-8527
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Pharmacy
Lab Director ANGELA G. FOSHEE

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