25D2140099 CLIA NUMBER - WALMART PHARMACY 10-2720

Laboratory Demographics

  • CLIA Code: 25D2140099
  • Facility Name: WALMART PHARMACY 10-2720
  • Facility Address: 127 GRANDVIEW BLVD
    MADISON, MS
    ZIP 39110
  • Facility Phone: 601 605-9615
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LORENA MOODY
  • NPI Number: 1982621306
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2140099
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2720
Street 127 GRANDVIEW BLVD
City MADISON
State MS
ZIP 39110
Phone 601 605-9615
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2023
Certificate Expiration Date 11/13/2025
Facility Type Pharmacy
Lab Director LORENA MOODY

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