25D2037882 CLIA NUMBER - WALGREENS #10909

Laboratory Demographics

  • CLIA Code: 25D2037882
  • Facility Name: WALGREENS #10909
  • Facility Address: 12007 LAMEY BRIDGE RD
    DIBERVILLE, MS
    ZIP 39540
  • Facility Phone: 228 392-2388
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROOSEVELT BLYE JR
  • NPI Number: 1972763092
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2037882
LAB Type Pharmacy
Facility Name WALGREENS #10909
Street 12007 LAMEY BRIDGE RD
City DIBERVILLE
State MS
ZIP 39540
Phone 228 392-2388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Pharmacy
Lab Director ROOSEVELT BLYE JR

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