15D2133237 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6313

Laboratory Demographics

  • CLIA Code: 15D2133237
  • Facility Name: SAM'S CLUB PHARMACY 10-6313
  • Facility Address: 6736 LIMA RD
    FORT WAYNE, IN
    ZIP 46818
  • Facility Phone: 260 490-0638
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AWUDU IMORO
  • NPI Number: 1861581662
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 15D2133237
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6313
Street 6736 LIMA RD
City FORT WAYNE
State IN
ZIP 46818
Phone 260 490-0638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Pharmacy
Lab Director AWUDU IMORO

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