04D2126517 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6377 SAM'S WEST, INC

Laboratory Demographics

  • CLIA Code: 04D2126517
  • Facility Name: SAM'S CLUB PHARMACY 10-6377 SAM'S WEST, INC
  • Facility Address: 2405 S CARAWAY RD
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 203-7055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WHITNEY MORALES
  • NPI Number: 1477893949
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2126517
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6377 SAM'S WEST, INC
Street 2405 S CARAWAY RD
City JONESBORO
State AR
ZIP 72401
Phone 870 203-7055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Pharmacy
Lab Director WHITNEY MORALES

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