25D2151963 CLIA NUMBER - NISSAN FAMILY PHARMACY

Laboratory Demographics

  • CLIA Code: 25D2151963
  • Facility Name: NISSAN FAMILY PHARMACY
  • Facility Address: 300 NISSAN DRIVE
    CANTON, MS
    ZIP 39046
  • Facility Phone: 601 407-1545
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARLA G. SMITH
  • NPI Number: 1669527677
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2151963
LAB Type Pharmacy
Facility Name NISSAN FAMILY PHARMACY
Street 300 NISSAN DRIVE
City CANTON
State MS
ZIP 39046
Phone 601 407-1545
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Pharmacy
Lab Director CARLA G. SMITH

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