14D2133008 CLIA NUMBER - SAM'S CLUB PHARMACY 06388

Laboratory Demographics

  • CLIA Code: 14D2133008
  • Facility Name: SAM'S CLUB PHARMACY 06388
  • Facility Address: 1050 OGDEN AVE
    MONTGOMERY, IL
    ZIP 60538
  • Facility Phone: 630 449-1953
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAITRI M. DESAI
  • NPI Number: 1295152635
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2133008
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 06388
Street 1050 OGDEN AVE
City MONTGOMERY
State IL
ZIP 60538
Phone 630 449-1953
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 MAITRI M. DESAI

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