25D2140679 CLIA NUMBER - WALMART PHARMACY 10-3593

Laboratory Demographics

  • CLIA Code: 25D2140679
  • Facility Name: WALMART PHARMACY 10-3593
  • Facility Address: 2401 GOODMAN RD W
    HORN LAKE, MS
    ZIP 38637
  • Facility Phone: 662 342-6229
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAMISHA MARCH
  • NPI Number: 1164449583
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2140679
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3593
Street 2401 GOODMAN RD W
City HORN LAKE
State MS
ZIP 38637
Phone 662 342-6229
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2023
Certificate Expiration Date 11/27/2025
Facility Type Pharmacy
Lab Director TAMISHA MARCH

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