03D2126734 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4955

Laboratory Demographics

  • CLIA Code: 03D2126734
  • Facility Name: SAM'S CLUB PHARMACY 10-4955
  • Facility Address: 16573 W BELL RD
    SURPRISE, AZ
    ZIP 85374
  • Facility Phone: 623 584-0728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALFONSO A. GUAGENTI
  • NPI Number: 1689810533
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2126734
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4955
Street 16573 W BELL RD
City SURPRISE
State AZ
ZIP 85374
Phone 623 584-0728
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 ALFONSO A. GUAGENTI

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