25D2120165 CLIA NUMBER - WALMART PHARMACY 10-6964

Laboratory Demographics

  • CLIA Code: 25D2120165
  • Facility Name: WALMART PHARMACY 10-6964
  • Facility Address: 4150 GOODMAN RD W
    HORN LAKE, MS
    ZIP 38637
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHLEEN KIMBALL
  • NPI Number: 1184098733
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2120165
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-6964
Street 4150 GOODMAN RD W
City HORN LAKE
State MS
ZIP 38637
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 KATHLEEN KIMBALL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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