25D2127437 CLIA NUMBER - WALMART PHARMACY 10-6166

Laboratory Demographics

CLIA Number: 25D2127437

Facility Name: WALMART PHARMACY 10-6166

Facility Address:
10290 DIBERVILLE RD
DIBERVILLE, MS
ZIP 39540
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Facility Phone Number: 228 271-6753

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1952710493

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	25D2127437
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-6166
Street	10290 DIBERVILLE RD
City	DIBERVILLE
State	MS
ZIP	39540
Phone	228 271-6753
CertificateType	4
CertificateEffectiveDate	3/14/2023
CertificateExpirationDate	3/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024