25D2037854 CLIA NUMBER - WALGREENS #10360

Laboratory Demographics

  • CLIA Code: 25D2037854
  • Facility Name: WALGREENS #10360
  • Facility Address: 2601 HWY 90
    GAUTIER, MS
    ZIP 39553
  • Facility Phone: 228 497-8110
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ADDISON PHAN
  • NPI Number: 1821289398
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2037854
LAB Type Pharmacy
Facility Name WALGREENS #10360
Street 2601 HWY 90
City GAUTIER
State MS
ZIP 39553
Phone 228 497-8110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director ADDISON PHAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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