04D2128126 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8134 SAM'S WEST, INC

Laboratory Demographics

  • CLIA Code: 04D2128126
  • Facility Name: SAM'S CLUB PHARMACY 10-8134 SAM'S WEST, INC
  • Facility Address: 7700 ROGERS AVE
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 484-8008
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEPH ESTRADA
  • NPI Number: 1285721985
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2128126
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8134 SAM'S WEST, INC
Street 7700 ROGERS AVE
City FORT SMITH
State AR
ZIP 72903
Phone 479 484-8008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director JOSEPH ESTRADA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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