14D2132992 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8297

Laboratory Demographics

  • CLIA Code: 14D2132992
  • Facility Name: SAM'S CLUB PHARMACY 10-8297
  • Facility Address: 7151 WALTON ST
    ROCKFORD, IL
    ZIP 61108
  • Facility Phone: 815 397-4291
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TOMASZ KACZOR
  • NPI Number: 1316048572
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2132992
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8297
Street 7151 WALTON ST
City ROCKFORD
State IL
ZIP 61108
Phone 815 397-4291
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 TOMASZ KACZOR

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