25D2037822 CLIA NUMBER - WALGREENS #12269

Laboratory Demographics

  • CLIA Code: 25D2037822
  • Facility Name: WALGREENS #12269
  • Facility Address: 329 SUNSET DR
    GRENADA, MS
    ZIP 38901
  • Facility Phone: 662 226-6631
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASMINE EDWARDS
  • NPI Number: 1972764785
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2037822
LAB Type Pharmacy
Facility Name WALGREENS #12269
Street 329 SUNSET DR
City GRENADA
State MS
ZIP 38901
Phone 662 226-6631
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Pharmacy
Lab Director JASMINE EDWARDS

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