25D2139636 CLIA NUMBER - WALMART PHARMACY 10-1195

Laboratory Demographics

  • CLIA Code: 25D2139636
  • Facility Name: WALMART PHARMACY 10-1195
  • Facility Address: 460 HWY 90
    WAVELAND, MS
    ZIP 39576
  • Facility Phone: 228 467-4717
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHUC NGUYEN
  • NPI Number: 1174540587
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2139636
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1195
Street 460 HWY 90
City WAVELAND
State MS
ZIP 39576
Phone 228 467-4717
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Pharmacy
Lab Director PHUC NGUYEN

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