19D2133604 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4109

Laboratory Demographics

  • CLIA Code: 19D2133604
  • Facility Name: SAM'S CLUB PHARMACY 10-4109
  • Facility Address: 2861 BEENE BLVD
    BOSSIER CITY, LA
    ZIP 71111
  • Facility Phone: 318 606-6178
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN H. CUNNINGHAM
  • NPI Number: 1629481353
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2133604
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4109
Street 2861 BEENE BLVD
City BOSSIER CITY
State LA
ZIP 71111
Phone 318 606-6178
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2025
Certificate Expiration Date 7/16/2027
Facility Type Pharmacy
Lab Director JOHN H. CUNNINGHAM

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