25D2041701 CLIA NUMBER - WALGREENS #07579

Laboratory Demographics

  • CLIA Code: 25D2041701
  • Facility Name: WALGREENS #07579
  • Facility Address: 5093 HARDY STREET
    HATTIESBURG, MS
    ZIP 39402
  • Facility Phone: 601 579-6698
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEWELL L. JACKSON
  • NPI Number: 1558376715
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2041701
LAB Type Pharmacy
Facility Name WALGREENS #07579
Street 5093 HARDY STREET
City HATTIESBURG
State MS
ZIP 39402
Phone 601 579-6698
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director DEWELL L. JACKSON

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