15D2133207 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6315

Laboratory Demographics

  • CLIA Code: 15D2133207
  • Facility Name: SAM'S CLUB PHARMACY 10-6315
  • Facility Address: 120 INDIAN RIDGE BLVD
    MISHAWAKA, IN
    ZIP 46545
  • Facility Phone: 574 243-8419
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON YOUNG
  • NPI Number: 1033210679
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2133207
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6315
Street 120 INDIAN RIDGE BLVD
City MISHAWAKA
State IN
ZIP 46545
Phone 574 243-8419
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Pharmacy
Lab Director JASON YOUNG

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