06D2129157 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6633

Laboratory Demographics

  • CLIA Code: 06D2129157
  • Facility Name: SAM'S CLUB PHARMACY 10-6633
  • Facility Address: 4700 BOARDWALK DR
    FORT COLLINS, CO
    ZIP 80525
  • Facility Phone: 970 204-7817
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ERIC T. REWERTS
  • NPI Number: 1356427546
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 06D2129157
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6633
Street 4700 BOARDWALK DR
City FORT COLLINS
State CO
ZIP 80525
Phone 970 204-7817
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Pharmacy
Lab Director DR. ERIC T. REWERTS

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