03D2126866 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6205

Laboratory Demographics

  • CLIA Code: 03D2126866
  • Facility Name: SAM'S CLUB PHARMACY 10-6205
  • Facility Address: 1462 S PACIFIC AVE
    YUMA, AZ
    ZIP 85365
  • Facility Phone: 928 783-6575
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW C. MARTIN
  • NPI Number: 1639260177
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 03D2126866
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6205
Street 1462 S PACIFIC AVE
City YUMA
State AZ
ZIP 85365
Phone 928 783-6575
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 MATTHEW C. MARTIN

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