14D2132994 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8215

Laboratory Demographics

  • CLIA Code: 14D2132994
  • Facility Name: SAM'S CLUB PHARMACY 10-8215
  • Facility Address: 2300 W WHITE OAKS DR
    SPRINGFIELD, IL
    ZIP 62704
  • Facility Phone: 217 698-5938
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAUREN R. BALLWEG
  • NPI Number: 1245311919
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2132994
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8215
Street 2300 W WHITE OAKS DR
City SPRINGFIELD
State IL
ZIP 62704
Phone 217 698-5938
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 LAUREN R. BALLWEG

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