15D2133210 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6325

Laboratory Demographics

  • CLIA Code: 15D2133210
  • Facility Name: SAM'S CLUB PHARMACY 10-6325
  • Facility Address: 1101 WINDHORST WAY
    GREENWOOD, IN
    ZIP 46143
  • Facility Phone: 317 887-0093
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS PETRO
  • NPI Number: 1720162480
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2133210
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6325
Street 1101 WINDHORST WAY
City GREENWOOD
State IN
ZIP 46143
Phone 317 887-0093
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 NICHOLAS PETRO

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