10D2169243 CLIA NUMBER - COSTCO PHARMACY #1364

Laboratory Demographics

  • CLIA Code: 10D2169243
  • Facility Name: COSTCO PHARMACY #1364
  • Facility Address: 805 LIGHTHOUSE DR
    BRADENTON, FL
    ZIP 34212
  • Facility Phone: 425 313-6275
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REBEKAH M. DANT
  • NPI Number: 1134789639
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2169243
LAB Type Pharmacy
Facility Name COSTCO PHARMACY #1364
Street 805 LIGHTHOUSE DR
City BRADENTON
State FL
ZIP 34212
Phone 425 313-6275
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Pharmacy
Lab Director REBEKAH M. DANT

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