16D2135553 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6472

Laboratory Demographics

  • CLIA Code: 16D2135553
  • Facility Name: SAM'S CLUB PHARMACY 10-6472
  • Facility Address: 3221 MANAWA SENTRE DRIVE
    COUNCIL BLUFFS, IA
    ZIP 51501
  • Facility Phone: 712 366-7032
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CRAIG ECABERT
  • NPI Number: 1053415091
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 16D2135553
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6472
Street 3221 MANAWA SENTRE DRIVE
City COUNCIL BLUFFS
State IA
ZIP 51501
Phone 712 366-7032
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/23/2025
Certificate Expiration Date 8/22/2027
Facility Type Pharmacy
Lab Director CRAIG ECABERT

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