25D2230894 CLIA NUMBER - WALGREENS #17031

Laboratory Demographics

  • CLIA Code: 25D2230894
  • Facility Name: WALGREENS #17031
  • Facility Address: 11279 HWY 49
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 832-6280
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANNON G. WHITAKER
  • NPI Number: 1912420910
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2230894
LAB Type Pharmacy
Facility Name WALGREENS #17031
Street 11279 HWY 49
City GULFPORT
State MS
ZIP 39503
Phone 228 832-6280
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director SHANNON G. WHITAKER

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