21D2143869 CLIA NUMBER - SAMS CLUB PHARMACY 10-6650

Laboratory Demographics

  • CLIA Code: 21D2143869
  • Facility Name: SAMS CLUB PHARMACY 10-6650
  • Facility Address: 6410 PETRIE WAY ROAD
    ROSEDALE, MD
    ZIP 21237
  • Facility Phone: 410 686-7649
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT A. MAURER
  • NPI Number: 1720174550
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 21D2143869
LAB Type Pharmacy
Facility Name SAMS CLUB PHARMACY 10-6650
Street 6410 PETRIE WAY ROAD
City ROSEDALE
State MD
ZIP 21237
Phone 410 686-7649
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Pharmacy
Lab Director SCOTT A. MAURER

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