25D2037842 CLIA NUMBER - WALGREENS #07517

Laboratory Demographics

  • CLIA Code: 25D2037842
  • Facility Name: WALGREENS #07517
  • Facility Address: 977 ELLIS AVE
    JACKSON, MS
    ZIP 39209
  • Facility Phone: 601 944-9965
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALLISON G. THIGPEN
  • NPI Number: 1649285800
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2037842
LAB Type Pharmacy
Facility Name WALGREENS #07517
Street 977 ELLIS AVE
City JACKSON
State MS
ZIP 39209
Phone 601 944-9965
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Pharmacy
Lab Director ALLISON G. THIGPEN

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