25D2127408 CLIA NUMBER - WALMART PHARMACY 10-0495

Laboratory Demographics

  • CLIA Code: 25D2127408
  • Facility Name: WALMART PHARMACY 10-0495
  • Facility Address: 1913 HWY 45 N FRONTAGE RD
    COLUMBUS, MS
    ZIP 39705
  • Facility Phone: 662 329-1766
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK JAGGERS
  • NPI Number: 1346267747
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2127408
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0495
Street 1913 HWY 45 N FRONTAGE RD
City COLUMBUS
State MS
ZIP 39705
Phone 662 329-1766
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 MARK JAGGERS

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