25D2029486 CLIA NUMBER - WALGREENS #01166

Laboratory Demographics

  • CLIA Code: 25D2029486
  • Facility Name: WALGREENS #01166
  • Facility Address: 719 BROOKWAY BLVD
    BROOKHAVEN, MS
    ZIP 39601
  • Facility Phone: 601 833-8509
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEMBE KEYS
  • NPI Number: 1093720252
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2029486
LAB Type Pharmacy
Facility Name WALGREENS #01166
Street 719 BROOKWAY BLVD
City BROOKHAVEN
State MS
ZIP 39601
Phone 601 833-8509
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 KEMBE KEYS

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