17D2137926 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6418

Laboratory Demographics

  • CLIA Code: 17D2137926
  • Facility Name: SAM'S CLUB PHARMACY 10-6418
  • Facility Address: 3415 N ROCK RD
    WICHITA, KS
    ZIP 67226
  • Facility Phone: 316 636-2009
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AUSTIN K. HEAVNER
  • NPI Number: 1023108271
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 17D2137926
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6418
Street 3415 N ROCK RD
City WICHITA
State KS
ZIP 67226
Phone 316 636-2009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2025
Certificate Expiration Date 10/5/2027
Facility Type Pharmacy
Lab Director AUSTIN K. HEAVNER

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