03D2126731 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4915

Laboratory Demographics

  • CLIA Code: 03D2126731
  • Facility Name: SAM'S CLUB PHARMACY 10-4915
  • Facility Address: 600 HIGHWAY 95, STE 200
    BULLHEAD CITY, AZ
    ZIP 86429
  • Facility Phone: 928 754-3961
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CAROL SAN VICENTE
  • NPI Number: 1659752145
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2126731
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4915
Street 600 HIGHWAY 95, STE 200
City BULLHEAD CITY
State AZ
ZIP 86429
Phone 928 754-3961
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 CAROL SAN VICENTE

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