25D2115407 CLIA NUMBER - WALMART PHARMACY 10-2715

Laboratory Demographics

  • CLIA Code: 25D2115407
  • Facility Name: WALMART PHARMACY 10-2715
  • Facility Address: 3615 SANGANI BLVD
    DIBERVILLE, MS
    ZIP 39540
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HOLLY BURKE
  • NPI Number: 1891712212
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2115407
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2715
Street 3615 SANGANI BLVD
City DIBERVILLE
State MS
ZIP 39540
Phone 479 258-2243
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Pharmacy
Lab Director HOLLY BURKE

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