44D2316456 CLIA NUMBER - SOUTHERN EXPRESS PHARMACY

Laboratory Demographics

  • CLIA Code: 44D2316456
  • Facility Name: SOUTHERN EXPRESS PHARMACY
  • Facility Address: 1355 W MARKET ST
    BOLIVAR, TN
    ZIP 38008
  • Facility Phone: 731 472-1011
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELIZABETH A. WILLIS
  • NPI Number: 1073078481
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 44D2316456
LAB Type Pharmacy
Facility Name SOUTHERN EXPRESS PHARMACY
Street 1355 W MARKET ST
City BOLIVAR
State TN
ZIP 38008
Phone 731 472-1011
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/6/2025
Certificate Expiration Date 1/5/2027
Facility Type Pharmacy
Lab Director ELIZABETH A. WILLIS

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