25D2037829 CLIA NUMBER - WALGREENS #10430

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Laboratory Demographics

CLIA Number: 25D2037829

Facility Name: WALGREENS #10430

Facility Address:
103 WEST CENTRAL AVENUE
PETAL, MS
ZIP 39465
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Facility Phone Number: 601 554-3236

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1568562346

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	25D2037829
LAB Type	Pharmacy
Facility Name	WALGREENS #10430
Street	103 WEST CENTRAL AVENUE
City	PETAL
State	MS
ZIP	39465
Phone	601 554-3236
CertificateType	4
CertificateEffectiveDate	4/13/2023
CertificateExpirationDate	4/12/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024