03D2126862 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6692

Laboratory Demographics

  • CLIA Code: 03D2126862
  • Facility Name: SAM'S CLUB PHARMACY 10-6692
  • Facility Address: 4701 N STONE AVE
    TUCSON, AZ
    ZIP 85704
  • Facility Phone: 520 292-0009
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAY WISE
  • NPI Number: 1124101613
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2126862
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6692
Street 4701 N STONE AVE
City TUCSON
State AZ
ZIP 85704
Phone 520 292-0009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/7/2025
Certificate Expiration Date 3/6/2027
Facility Type Pharmacy
Lab Director JAY WISE

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