19D2133610 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4775

Laboratory Demographics

  • CLIA Code: 19D2133610
  • Facility Name: SAM'S CLUB PHARMACY 10-4775
  • Facility Address: 3900 AIRLINE
    METAIRIE, LA
    ZIP 70001
  • Facility Phone: 504 831-8484
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PORSCHE C. FORMAN
  • NPI Number: 1457448854
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 19D2133610
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4775
Street 3900 AIRLINE
City METAIRIE
State LA
ZIP 70001
Phone 504 831-8484
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 PORSCHE C. FORMAN

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