25D2210619 CLIA NUMBER - NORTHTOWN PHARMACY

Laboratory Demographics

  • CLIA Code: 25D2210619
  • Facility Name: NORTHTOWN PHARMACY
  • Facility Address: 6220 OLD CANTON ROAD
    JACKSON, MS
    ZIP 39211
  • Facility Phone: 601 503-0558
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW CLARK
  • NPI Number: 1023614724
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2210619
LAB Type Pharmacy
Facility Name NORTHTOWN PHARMACY
Street 6220 OLD CANTON ROAD
City JACKSON
State MS
ZIP 39211
Phone 601 503-0558
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/22/2025
Certificate Expiration Date 1/21/2027
Facility Type Pharmacy
Lab Director ANDREW CLARK

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