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

Laboratory Demographics

CLIA Number: 06D2118582

Facility Name: SAM'S CLUB PHARMACY #10-4987

Facility Address:
1200 SOUTH HOVER
LONGMONT, CO
ZIP 80501
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Facility Phone Number: 303 845-4219

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1285092577

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

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
CertificateType	4
CertificateEffectiveDate	9/12/2022
CertificateExpirationDate	9/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024