18D2126791 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4728

Laboratory Demographics

  • CLIA Code: 18D2126791
  • Facility Name: SAM'S CLUB PHARMACY 10-4728
  • Facility Address: 103 BRYANT DRIVE
    NICHOLASVILLE, KY
    ZIP 40356
  • Facility Phone: 479 204-2258
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JON QUILLEN
  • NPI Number: 1295040665
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 18D2126791
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4728
Street 103 BRYANT DRIVE
City NICHOLASVILLE
State KY
ZIP 40356
Phone 479 204-2258
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 JON QUILLEN

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