25D2127400 CLIA NUMBER - WALMART PHARMACY 10-0785

Laboratory Demographics

  • CLIA Code: 25D2127400
  • Facility Name: WALMART PHARMACY 10-0785
  • Facility Address: 1350 AZALEA DRIVE
    WAYNESBORO, MS
    ZIP 39367
  • Facility Phone: 601 735-3194
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMESHIA GRAVES
  • NPI Number: 1548287048
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2127400
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0785
Street 1350 AZALEA DRIVE
City WAYNESBORO
State MS
ZIP 39367
Phone 601 735-3194
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 JAMESHIA GRAVES

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