18D2126788 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4876

Laboratory Demographics

CLIA Number: 18D2126788

Facility Name: SAM'S CLUB PHARMACY 10-4876

Facility Address:
3200 KEN BALE BLVD
BOWLING GREEN, KY
ZIP 42103
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Facility Phone Number: 270 781-7727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1225581820

Taxonomy: 251K00000X - Public Health or Welfare

CLIA Record

Field Name	Field Value
CLIA Number	18D2126788
LAB Type	Pharmacy
Facility Name	SAM'S CLUB PHARMACY 10-4876
Street	3200 KEN BALE BLVD
City	BOWLING GREEN
State	KY
ZIP	42103
Phone	270 781-7727
CertificateType	4
CertificateEffectiveDate	3/6/2023
CertificateExpirationDate	3/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024