01D2146157 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8106

Laboratory Demographics

  • CLIA Code: 01D2146157
  • Facility Name: SAM'S CLUB PHARMACY 10-8106
  • Facility Address: 1080 EASTERN BLVD
    MONTGOMERY, AL
    ZIP 36117
  • Facility Phone: 334 277-5454
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHIANGCHANH PHOTHISANE
  • NPI Number: 1457441792
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 01D2146157
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8106
Street 1080 EASTERN BLVD
City MONTGOMERY
State AL
ZIP 36117
Phone 334 277-5454
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 CHIANGCHANH PHOTHISANE

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