01D2146154 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4990

Laboratory Demographics

  • CLIA Code: 01D2146154
  • Facility Name: SAM'S CLUB PHARMACY 10-4990
  • Facility Address: 29683 FREDERICK BLVD
    DAPHNE, AL
    ZIP 36526
  • Facility Phone: 251 626-6670
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOGAN R. ROSS
  • NPI Number: 1073737441
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 01D2146154
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4990
Street 29683 FREDERICK BLVD
City DAPHNE
State AL
ZIP 36526
Phone 251 626-6670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2024
Certificate Expiration Date 3/21/2026
Facility Type Pharmacy
Lab Director LOGAN R. ROSS

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