25D2129530 CLIA NUMBER - WALMART PHARMACY 10-0970

Laboratory Demographics

  • CLIA Code: 25D2129530
  • Facility Name: WALMART PHARMACY 10-0970
  • Facility Address: 235 FRONTAGE RD
    PICAYUNE, MS
    ZIP 39466
  • Facility Phone: 601 799-1063
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLYN SIMMONS
  • NPI Number: 1720005135
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2129530
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0970
Street 235 FRONTAGE RD
City PICAYUNE
State MS
ZIP 39466
Phone 601 799-1063
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director ASHLYN SIMMONS

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