25D2037829 CLIA NUMBER - WALGREENS #10430

Laboratory Demographics

  • CLIA Code: 25D2037829
  • Facility Name: WALGREENS #10430
  • Facility Address: 103 WEST CENTRAL AVENUE
    PETAL, MS
    ZIP 39465
  • Facility Phone: 601 554-3236
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLEMAN R. SISSON
  • NPI Number: 1568562346
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director COLEMAN R. SISSON

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