14D2132996 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8184

Laboratory Demographics

  • CLIA Code: 14D2132996
  • Facility Name: SAM'S CLUB PHARMACY 10-8184
  • Facility Address: 6570 GRAND AVE
    GURNEE, IL
    ZIP 60031
  • Facility Phone: 847 855-8621
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GAVIN HUTSON
  • NPI Number: 1124129887
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2132996
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8184
Street 6570 GRAND AVE
City GURNEE
State IL
ZIP 60031
Phone 847 855-8621
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 GAVIN HUTSON

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