25D2035644 CLIA NUMBER - WALGREENS #05396

Laboratory Demographics

  • CLIA Code: 25D2035644
  • Facility Name: WALGREENS #05396
  • Facility Address: 1011 GOODMAN RD E
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 349-6787
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MUSA J. CEESAY
  • NPI Number: 1245246719
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2035644
LAB Type Pharmacy
Facility Name WALGREENS #05396
Street 1011 GOODMAN RD E
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 349-6787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Pharmacy
Lab Director MUSA J. CEESAY

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