25D2133203 CLIA NUMBER - WALMART PHARMACY 10-1059

Laboratory Demographics

CLIA Number: 25D2133203

Facility Name: WALMART PHARMACY 10-1059

Facility Address:
1309 HIGHWAY 35 S
FOREST, MS
ZIP 39074
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Facility Phone Number: 601 469-2190

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1184641599

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	25D2133203
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-1059
Street	1309 HIGHWAY 35 S
City	FOREST
State	MS
ZIP	39074
Phone	601 469-2190
CertificateType	4
CertificateEffectiveDate	7/7/2023
CertificateExpirationDate	7/6/2025
FacilityType	Waiver

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