25D2029478 CLIA NUMBER - WALGREENS #11171

Laboratory Demographics

  • CLIA Code: 25D2029478
  • Facility Name: WALGREENS #11171
  • Facility Address: 700 W PARK AVE
    GREENWOOD, MS
    ZIP 38930
  • Facility Phone: 662 451-1121
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAO WEN
  • NPI Number: 1750588091
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2029478
LAB Type Pharmacy
Facility Name WALGREENS #11171
Street 700 W PARK AVE
City GREENWOOD
State MS
ZIP 38930
Phone 662 451-1121
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director TAO WEN

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