25D2230896 CLIA NUMBER - WALGREENS #17030

Laboratory Demographics

  • CLIA Code: 25D2230896
  • Facility Name: WALGREENS #17030
  • Facility Address: 2310 CLAY ST
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 661-5856
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENT W. GREER
  • NPI Number: 1194248294
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2230896
LAB Type Pharmacy
Facility Name WALGREENS #17030
Street 2310 CLAY ST
City VICKSBURG
State MS
ZIP 39180
Phone 601 661-5856
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 BRENT W. GREER

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