15D2133243 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6304

Laboratory Demographics

  • CLIA Code: 15D2133243
  • Facility Name: SAM'S CLUB PHARMACY 10-6304
  • Facility Address: 5805 ROCKVILLE RD
    INDIANAPOLIS, IN
    ZIP 46224
  • Facility Phone: (317) 241-1141
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LYMAN MORRIS
  • NPI Number: 1881875524
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 15D2133243
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6304
Street 5805 ROCKVILLE RD
City INDIANAPOLIS
State IN
ZIP 46224
Phone 3172411141
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 LYMAN MORRIS

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This page was last updated on: 5/18/2026