15D2133249 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8169

Laboratory Demographics

  • CLIA Code: 15D2133249
  • Facility Name: SAM'S CLUB PHARMACY 10-8169
  • Facility Address: 3819 SOUTH STREET
    LAFAYETTE, IN
    ZIP 47905
  • Facility Phone: (765) 446-0575
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICK A. STACHELSKI

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CLIA Record

Field Name Field Value
CLIA Number 15D2133249
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8169
Street 3819 SOUTH STREET
City LAFAYETTE
State IN
ZIP 47905
Phone 7654460575
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 NICK A. STACHELSKI

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