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25D2239297 CLIA NUMBER - WALGREENS #15804

Laboratory Demographics

CLIA Number: 25D2239297

Facility Name: WALGREENS #15804

Facility Address:
1357 VETERANS MEMORIAL BLVD
EUPORA, MS
ZIP 39744
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Facility Phone Number: 662 258-2631

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1013096783

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 25D2239297
LAB Type Pharmacy
Facility Name WALGREENS #15804
Street 1357 VETERANS MEMORIAL BLVD
City EUPORA
State MS
ZIP 39744
Phone 662 258-2631
CertificateType 4
CertificateEffectiveDate 10/11/2023
CertificateExpirationDate 10/10/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024