03D2126729 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6604

Laboratory Demographics

  • CLIA Code: 03D2126729
  • Facility Name: SAM'S CLUB PHARMACY 10-6604
  • Facility Address: 1851 E BUTLER AVE
    FLAGSTAFF, AZ
    ZIP 86001
  • Facility Phone: 928 774-3293
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARYN GUNDERSEN
  • NPI Number: 1740379627
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2126729
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6604
Street 1851 E BUTLER AVE
City FLAGSTAFF
State AZ
ZIP 86001
Phone 928 774-3293
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 CARYN GUNDERSEN

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This page was last updated on: 3/20/2025