25D2139664 CLIA NUMBER - WALMART PHARMACY 10-5079

Laboratory Demographics

  • CLIA Code: 25D2139664
  • Facility Name: WALMART PHARMACY 10-5079
  • Facility Address: 1617 EAST BEACH BLVD
    PASS CHRISTIAN, MS
    ZIP 39571
  • Facility Phone: 228 452-7890
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON KING
  • NPI Number: 1831322858
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2139664
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5079
Street 1617 EAST BEACH BLVD
City PASS CHRISTIAN
State MS
ZIP 39571
Phone 228 452-7890
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 BRANDON KING

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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