25D2140144 CLIA NUMBER - WALMART PHARMACY 10-0114

Laboratory Demographics

  • CLIA Code: 25D2140144
  • Facility Name: WALMART PHARMACY 10-0114
  • Facility Address: 300 WALMART CIR
    BOONEVILLE, MS
    ZIP 38829
  • Facility Phone: 662 728-6863
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LORI B. HORN
  • NPI Number: 1255358669
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2140144
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0114
Street 300 WALMART CIR
City BOONEVILLE
State MS
ZIP 38829
Phone 662 728-6863
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/15/2023
Certificate Expiration Date 11/14/2025
Facility Type Pharmacy
Lab Director LORI B. HORN

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