25D2194086 CLIA NUMBER - MAGIC MART PHARMACY

Laboratory Demographics

  • CLIA Code: 25D2194086
  • Facility Name: MAGIC MART PHARMACY
  • Facility Address: 903 HWY 82 E BLDG G
    INDIANOLA, MS
    ZIP 38751
  • Facility Phone: 662 887-4135
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GUY M. PHILLIPS
  • NPI Number: 1194804591
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2194086
LAB Type Pharmacy
Facility Name MAGIC MART PHARMACY
Street 903 HWY 82 E BLDG G
City INDIANOLA
State MS
ZIP 38751
Phone 662 887-4135
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Pharmacy
Lab Director GUY M. PHILLIPS

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