25D2125981 CLIA NUMBER - SAM'S PHARMACY 10-4790

Laboratory Demographics

  • CLIA Code: 25D2125981
  • Facility Name: SAM'S PHARMACY 10-4790
  • Facility Address: 90 BASS PRO DR
    PEARL, MS
    ZIP 39208
  • Facility Phone: 601 939-6442
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE MCELROY-LIDDELL
  • NPI Number: 1285868653
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2125981
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-4790
Street 90 BASS PRO DR
City PEARL
State MS
ZIP 39208
Phone 601 939-6442
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Pharmacy
Lab Director STEPHANIE MCELROY-LIDDELL

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