03D2130704 CLIA NUMBER - SAM'S WEST, INC DBA SAM'S CLUB PHARMACY #10-4732

Laboratory Demographics

  • CLIA Code: 03D2130704
  • Facility Name: SAM'S WEST, INC DBA SAM'S CLUB PHARMACY #10-4732
  • Facility Address: 18501 N 83RD AVE
    GLENDALE, AZ
    ZIP 85308
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENT W. MCINTOSH
  • NPI Number: 1063439289
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2130704
LAB Type Pharmacy
Facility Name SAM'S WEST, INC DBA SAM'S CLUB PHARMACY #10-4732
Street 18501 N 83RD AVE
City GLENDALE
State AZ
ZIP 85308
Phone 479 258-7034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2025
Certificate Expiration Date 5/15/2027
Facility Type Pharmacy
Lab Director BRENT W. MCINTOSH

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This page was last updated on: 6/4/2025