14D2132988 CLIA NUMBER - SAM'S CLUB PHARMACY 4815

Laboratory Demographics

  • CLIA Code: 14D2132988
  • Facility Name: SAM'S CLUB PHARMACY 4815
  • Facility Address: 2151 SHEPARD RD
    NORMAL, IL
    ZIP 61761
  • Facility Phone: 309 454-5478
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMES MORENO
  • NPI Number: 1104912161
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2132988
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 4815
Street 2151 SHEPARD RD
City NORMAL
State IL
ZIP 61761
Phone 309 454-5478
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 JAMES MORENO

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