19D2136386 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6527

Laboratory Demographics

  • CLIA Code: 19D2136386
  • Facility Name: SAM'S CLUB PHARMACY 10-6527
  • Facility Address: 10444 N MALL DR
    BATON ROUGE, LA
    ZIP 70809
  • Facility Phone: 225 295-0914
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEKISHEON BROWN
  • NPI Number: 1861573461
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 19D2136386
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6527
Street 10444 N MALL DR
City BATON ROUGE
State LA
ZIP 70809
Phone 225 295-0914
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2025
Certificate Expiration Date 9/7/2027
Facility Type Pharmacy
Lab Director DEKISHEON BROWN

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