06D2128091 CLIA NUMBER - SAM'S CLUB PHARMACY #10-4770

Laboratory Demographics

  • CLIA Code: 06D2128091
  • Facility Name: SAM'S CLUB PHARMACY #10-4770
  • Facility Address: 3247 23RD AVE
    EVANS, CO
    ZIP 80620
  • Facility Phone: 970 330-5739
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEX GOMEZ MEDNOZA
  • NPI Number: 1619125903
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 06D2128091
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY #10-4770
Street 3247 23RD AVE
City EVANS
State CO
ZIP 80620
Phone 970 330-5739
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 ALEX GOMEZ MEDNOZA

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