25D2120181 CLIA NUMBER - WALMART PHARMACY 10-0848

Laboratory Demographics

  • CLIA Code: 25D2120181
  • Facility Name: WALMART PHARMACY 10-0848
  • Facility Address: 6811 SOUTHCREST PKWY
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON DETERDING
  • NPI Number: 1427075829
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2120181
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0848
Street 6811 SOUTHCREST PKWY
City SOUTHAVEN
State MS
ZIP 38671
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 BRANDON DETERDING

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