25D2037840 CLIA NUMBER - WALGREENS #12536

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Laboratory Demographics

CLIA Number: 25D2037840

Facility Name: WALGREENS #12536

Facility Address:
219 WOOLAND DRIVE NORTH
FOREST, MS
ZIP 39074
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Facility Phone Number: 601 469-3393

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1881839421

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	25D2037840
LAB Type	Pharmacy
Facility Name	WALGREENS #12536
Street	219 WOOLAND DRIVE NORTH
City	FOREST
State	MS
ZIP	39074
Phone	601 469-3393
CertificateType	4
CertificateEffectiveDate	4/5/2023
CertificateExpirationDate	4/4/2025
FacilityType	Waiver

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