04D2125269 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4808

Laboratory Demographics

  • CLIA Code: 04D2125269
  • Facility Name: SAM'S CLUB PHARMACY 10-4808
  • Facility Address: 1517 GENE GEORGE BLVD
    SPRINGDALE, AR
    ZIP 72762
  • Facility Phone: 479 365-8134
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALYSSA C. CHARLTON
  • NPI Number: 1790223006
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 04D2125269
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4808
Street 1517 GENE GEORGE BLVD
City SPRINGDALE
State AR
ZIP 72762
Phone 479 365-8134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Pharmacy
Lab Director ALYSSA C. CHARLTON

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