03D2126723 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4830

Laboratory Demographics

  • CLIA Code: 03D2126723
  • Facility Name: SAM'S CLUB PHARMACY 10-4830
  • Facility Address: 1459 N DYSART RD
    AVONDALE, AZ
    ZIP 85323
  • Facility Phone: 623 882-3871
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CLAUDIA B. AVILEZ
  • NPI Number: 1508957721
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2126723
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4830
Street 1459 N DYSART RD
City AVONDALE
State AZ
ZIP 85323
Phone 623 882-3871
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Pharmacy
Lab Director CLAUDIA B. AVILEZ

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This page was last updated on: 6/4/2025