14D2133033 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6489

Laboratory Demographics

  • CLIA Code: 14D2133033
  • Facility Name: SAM'S CLUB PHARMACY 10-6489
  • Facility Address: 603 RIVER OAKS W
    CALUMET CITY, IL
    ZIP 60409
  • Facility Phone: 708 832-2684
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA FLORENCE-RAY
  • NPI Number: 1306947379
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2133033
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6489
Street 603 RIVER OAKS W
City CALUMET CITY
State IL
ZIP 60409
Phone 708 832-2684
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 LISA FLORENCE-RAY

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