25D2035645 CLIA NUMBER - WALGREENS #06754

Laboratory Demographics

  • CLIA Code: 25D2035645
  • Facility Name: WALGREENS #06754
  • Facility Address: 4028 GOODMAN RD W
    HORN LAKE, MS
    ZIP 38637
  • Facility Phone: 662 393-3477
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELSEY B. MIZE
  • NPI Number: 1063428530
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2035645
LAB Type Pharmacy
Facility Name WALGREENS #06754
Street 4028 GOODMAN RD W
City HORN LAKE
State MS
ZIP 38637
Phone 662 393-3477
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Pharmacy
Lab Director KELSEY B. MIZE

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