25D2139495 CLIA NUMBER - WALMART PHARMACY 10-0875

Laboratory Demographics

CLIA Number: 25D2139495

Facility Name: WALMART PHARMACY 10-0875

Facility Address:
815 S WHEATLEY STREET
RIDGELAND, MS
ZIP 39157
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Facility Phone Number: 601 956-1466

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1154348555

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	25D2139495
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0875
Street	815 S WHEATLEY STREET
City	RIDGELAND
State	MS
ZIP	39157
Phone	601 956-1466
CertificateType	4
CertificateEffectiveDate	11/3/2023
CertificateExpirationDate	11/2/2025
FacilityType	Waiver

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