06D2118582 CLIA NUMBER - SAM'S CLUB PHARMACY #10-4987

Laboratory Demographics

  • CLIA Code: 06D2118582
  • Facility Name: SAM'S CLUB PHARMACY #10-4987
  • Facility Address: 1200 SOUTH HOVER
    LONGMONT, CO
    ZIP 80501
  • Facility Phone: 303 845-4219
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL E. SHORE
  • NPI Number: 1285092577
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 06D2118582
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY #10-4987
Street 1200 SOUTH HOVER
City LONGMONT
State CO
ZIP 80501
Phone 303 845-4219
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/12/2024
Certificate Expiration Date 9/11/2026
Facility Type Pharmacy
Lab Director MICHAEL E. SHORE

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