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

Laboratory Demographics

CLIA Number: 03D2126723

Facility Name: SAM'S CLUB PHARMACY 10-4830

Facility Address:
1459 N DYSART RD
AVONDALE, AZ
ZIP 85323
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Facility Phone Number: (623) 882-3871

Facility Type: PHARMACY

Certificate Type: Waiver

NPI Number: 1508957721

Taxonomy: 156FX1800X - Technician/Technologist

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

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This page was last updated on: 3/23/2022