19D2133521 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4837

Laboratory Demographics

  • CLIA Code: 19D2133521
  • Facility Name: SAM'S CLUB PHARMACY 10-4837
  • Facility Address: 201 BASS PRO BLVD
    DENHAM SPRINGS, LA
    ZIP 70726
  • Facility Phone: 225 665-8153
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNY T. NGUYIN
  • NPI Number: 1316206717
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 19D2133521
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4837
Street 201 BASS PRO BLVD
City DENHAM SPRINGS
State LA
ZIP 70726
Phone 225 665-8153
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/14/2025
Certificate Expiration Date 7/13/2027
Facility Type Pharmacy
Lab Director KENNY T. NGUYIN

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