25D2127374 CLIA NUMBER - WALMART PHARMACY 10-1074

Laboratory Demographics

  • CLIA Code: 25D2127374
  • Facility Name: WALMART PHARMACY 10-1074
  • Facility Address: 1655 SUNSET DR
    GRENADA, MS
    ZIP 38901
  • Facility Phone: 662 226-6550
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JANET B. DICKEY
  • NPI Number: 1801813217
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2127374
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1074
Street 1655 SUNSET DR
City GRENADA
State MS
ZIP 38901
Phone 662 226-6550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2025
Certificate Expiration Date 3/12/2027
Facility Type Pharmacy
Lab Director JANET B. DICKEY

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