25D2139637 CLIA NUMBER - WALMART PHARMACY 10-1260

Laboratory Demographics

  • CLIA Code: 25D2139637
  • Facility Name: WALMART PHARMACY 10-1260
  • Facility Address: 11226 OLD 63 SOUTH
    LUCEDALE, MS
    ZIP 39452
  • Facility Phone: 601 947-4287
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BETTINA MORAN
  • NPI Number: 1558389080
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2139637
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1260
Street 11226 OLD 63 SOUTH
City LUCEDALE
State MS
ZIP 39452
Phone 601 947-4287
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 BETTINA MORAN

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