15D2136086 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6437

Laboratory Demographics

  • CLIA Code: 15D2136086
  • Facility Name: SAM'S CLUB PHARMACY 10-6437
  • Facility Address: 3205 WEST STATE HWY 45
    BLOOMINGTON, IN
    ZIP 47403
  • Facility Phone: 812 333-8903
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CASEY SUMMERS
  • NPI Number: 1487744678
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 15D2136086
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6437
Street 3205 WEST STATE HWY 45
City BLOOMINGTON
State IN
ZIP 47403
Phone 812 333-8903
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2025
Certificate Expiration Date 8/31/2027
Facility Type Pharmacy
Lab Director CASEY SUMMERS

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