25D2127406 CLIA NUMBER - WALMART PHARMACY 10-0239

Laboratory Demographics

  • CLIA Code: 25D2127406
  • Facility Name: WALMART PHARMACY 10-0239
  • Facility Address: 220 VETERANS MEMORIAL DR
    KOSCIUSKO, MS
    ZIP 39090
  • Facility Phone: 662 289-4593
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRESTON HUGGINS
  • NPI Number: 1720006257
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2127406
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0239
Street 220 VETERANS MEMORIAL DR
City KOSCIUSKO
State MS
ZIP 39090
Phone 662 289-4593
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 PRESTON HUGGINS

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