14D2132984 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6444

Laboratory Demographics

  • CLIA Code: 14D2132984
  • Facility Name: SAM'S CLUB PHARMACY 10-6444
  • Facility Address: 2450 MAIN ST
    EVANSTON, IL
    ZIP 60202
  • Facility Phone: 847 425-9428
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW HEISHMAN
  • NPI Number: 1457452401
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2132984
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6444
Street 2450 MAIN ST
City EVANSTON
State IL
ZIP 60202
Phone 847 425-9428
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/3/2025
Certificate Expiration Date 7/2/2027
Facility Type Pharmacy
Lab Director MATTHEW HEISHMAN

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