25D2120462 CLIA NUMBER - WALGREENS #16089

Laboratory Demographics

  • CLIA Code: 25D2120462
  • Facility Name: WALGREENS #16089
  • Facility Address: 310 MEADOWBROOK ROAD
    JACKSON, MS
    ZIP 39206
  • Facility Phone: 601 362-6409
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HAU DANG
  • NPI Number: 1013922277
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2120462
LAB Type Pharmacy
Facility Name WALGREENS #16089
Street 310 MEADOWBROOK ROAD
City JACKSON
State MS
ZIP 39206
Phone 601 362-6409
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director HAU DANG

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