25D2120153 CLIA NUMBER - WALMART PHARMACY 10-5419

Laboratory Demographics

  • CLIA Code: 25D2120153
  • Facility Name: WALMART PHARMACY 10-5419
  • Facility Address: 2600 MCINGVALE ROAD
    HERNANDO, MS
    ZIP 38632
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JODY FULPER
  • NPI Number: 1790702116
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2120153
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5419
Street 2600 MCINGVALE ROAD
City HERNANDO
State MS
ZIP 38632
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 10/11/2024
Certificate Expiration Date 10/10/2026
Facility Type Pharmacy
Lab Director JODY FULPER

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