13D2130030 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6345

Laboratory Demographics

  • CLIA Code: 13D2130030
  • Facility Name: SAM'S CLUB PHARMACY 10-6345
  • Facility Address: 700 E 17TH ST
    IDAHO FALLS, ID
    ZIP 83404
  • Facility Phone: 208 523-0831
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FRANK EGBERT
  • NPI Number: 1902990930
  • Taxonomy: 156FX1800X - Technician/Technologist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 13D2130030
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6345
Street 700 E 17TH ST
City IDAHO FALLS
State ID
ZIP 83404
Phone 208 523-0831
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2025
Certificate Expiration Date 4/30/2027
Facility Type Pharmacy
Lab Director FRANK EGBERT

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: 6/4/2025