25D2262576 CLIA NUMBER - MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY04997

Laboratory Demographics

CLIA Number: 25D2262576

Facility Name: MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY04997

Facility Address:
305 MEADOWBROOK RD
JACKSON, MS
ZIP 39206
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Facility Phone Number: 601 362-7970

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1235134065

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	25D2262576
LAB Type	Pharmacy
Facility Name	MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY04997
Street	305 MEADOWBROOK RD
City	JACKSON
State	MS
ZIP	39206
Phone	601 362-7970
CertificateType	4
CertificateEffectiveDate	6/15/2022
CertificateExpirationDate	6/14/2024
FacilityType	Waiver

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