25D2309342 CLIA NUMBER - PANOLA PHARMACY, LLC

Laboratory Demographics

  • CLIA Code: 25D2309342
  • Facility Name: PANOLA PHARMACY, LLC
  • Facility Address: 440 HIGHWAY 6 EAST
    BATESVILLE, MS
    ZIP 38606
  • Facility Phone: 662 855-1204
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER SULLIVANT
  • NPI Number: 1811731250
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2309342
LAB Type Pharmacy
Facility Name PANOLA PHARMACY, LLC
Street 440 HIGHWAY 6 EAST
City BATESVILLE
State MS
ZIP 38606
Phone 662 855-1204
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type Pharmacy
Lab Director JENNIFER SULLIVANT

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