06D2128089 CLIA NUMBER - SAM'S CLUB PHARMACY #10-4745

Laboratory Demographics

  • CLIA Code: 06D2128089
  • Facility Name: SAM'S CLUB PHARMACY #10-4745
  • Facility Address: 9601 GRANT ST
    THORNTON, CO
    ZIP 80229
  • Facility Phone: 303 453-4964
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WADE GUNSALLUS
  • NPI Number: 1417041708
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 06D2128089
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY #10-4745
Street 9601 GRANT ST
City THORNTON
State CO
ZIP 80229
Phone 303 453-4964
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 WADE GUNSALLUS

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