14D2133010 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6358

Laboratory Demographics

  • CLIA Code: 14D2133010
  • Facility Name: SAM'S CLUB PHARMACY 10-6358
  • Facility Address: 141 W NORTH AVE
    NORTHLAKE, IL
    ZIP 60164
  • Facility Phone: 708 492-1417
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL M. LYNCH
  • NPI Number: 1295835312
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2133010
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6358
Street 141 W NORTH AVE
City NORTHLAKE
State IL
ZIP 60164
Phone 708 492-1417
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 DANIEL M. LYNCH

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