18D2126790 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8111

Laboratory Demographics

  • CLIA Code: 18D2126790
  • Facility Name: SAM'S CLUB PHARMACY 10-8111
  • Facility Address: 1401 ALLIANT AVE
    JEFFERSONTOWN, KY
    ZIP 40299
  • Facility Phone: 502 267-4367
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PATRICIA F. BENTZ
  • NPI Number: 1205928736
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 18D2126790
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8111
Street 1401 ALLIANT AVE
City JEFFERSONTOWN
State KY
ZIP 40299
Phone 502 267-4367
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Pharmacy
Lab Director MS. PATRICIA F. BENTZ

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