25D2115753 CLIA NUMBER - WALMART PHARMACY 10-1346

Laboratory Demographics

CLIA Number: 25D2115753

Facility Name: WALMART PHARMACY 10-1346

Facility Address:
3911 BIENVILLE BLVD
OCEAN SPRINGS, MS
ZIP 39564
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Facility Phone Number: 479 258-2243

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1891712204

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	25D2115753
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-1346
Street	3911 BIENVILLE BLVD
City	OCEAN SPRINGS
State	MS
ZIP	39564
Phone	479 258-2243
CertificateType	4
CertificateEffectiveDate	7/12/2022
CertificateExpirationDate	7/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024