25D2127391 CLIA NUMBER - WALMART PHARMACY 10-1066

Laboratory Demographics

  • CLIA Code: 25D2127391
  • Facility Name: WALMART PHARMACY 10-1066
  • Facility Address: 4253 DENNY AVE
    PASCAGOULA, MS
    ZIP 39581
  • Facility Phone: 228 762-9343
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOLLY OBRYANT
  • NPI Number: 1992722300
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2127391
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1066
Street 4253 DENNY AVE
City PASCAGOULA
State MS
ZIP 39581
Phone 228 762-9343
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/14/2025
Certificate Expiration Date 3/13/2027
Facility Type Pharmacy
Lab Director MOLLY OBRYANT

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