25D2037880 CLIA NUMBER - WALGREENS #15484

Laboratory Demographics

  • CLIA Code: 25D2037880
  • Facility Name: WALGREENS #15484
  • Facility Address: 1417 E PASS ROAD
    GULFPORT, MS
    ZIP 39507
  • Facility Phone: 228 896-3870
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEVEN J. JURASZEK
  • NPI Number: 1295740454
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2037880
LAB Type Pharmacy
Facility Name WALGREENS #15484
Street 1417 E PASS ROAD
City GULFPORT
State MS
ZIP 39507
Phone 228 896-3870
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director STEVEN J. JURASZEK

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