14D2138639 CLIA NUMBER - SAMS CLUB PHARMACY 10-8197

Laboratory Demographics

  • CLIA Code: 14D2138639
  • Facility Name: SAMS CLUB PHARMACY 10-8197
  • Facility Address: 915 W MARKETVIEW DR
    CHAMPAIGN, IL
    ZIP 61822
  • Facility Phone: 217 352-1987
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC J. BOMBA
  • NPI Number: 1801977574
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2138639
LAB Type Pharmacy
Facility Name SAMS CLUB PHARMACY 10-8197
Street 915 W MARKETVIEW DR
City CHAMPAIGN
State IL
ZIP 61822
Phone 217 352-1987
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2025
Certificate Expiration Date 10/22/2027
Facility Type Pharmacy
Lab Director ERIC J. BOMBA

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