25D2139656 CLIA NUMBER - WALMART PHARMACY 10-0903

Laboratory Demographics

  • CLIA Code: 25D2139656
  • Facility Name: WALMART PHARMACY 10-0903
  • Facility Address: 2711 GREENWAY DRIVE
    JACKSON, MS
    ZIP 39204
  • Facility Phone: 601 922-2876
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HAKIM JAMISON
  • NPI Number: 1174540595
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2139656
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0903
Street 2711 GREENWAY DRIVE
City JACKSON
State MS
ZIP 39204
Phone 601 922-2876
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/7/2023
Certificate Expiration Date 11/6/2025
Facility Type Pharmacy
Lab Director HAKIM JAMISON

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