21D2143871 CLIA NUMBER - SAMS CLUB PHARMACY 10-6653

Laboratory Demographics

  • CLIA Code: 21D2143871
  • Facility Name: SAMS CLUB PHARMACY 10-6653
  • Facility Address: 610 N FREDERICK AVENUE
    GAITHERSBURG, MD
    ZIP 20877
  • Facility Phone: 240 631-7716
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHARAREH KHANJANI
  • NPI Number: 1649379173
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 21D2143871
LAB Type Pharmacy
Facility Name SAMS CLUB PHARMACY 10-6653
Street 610 N FREDERICK AVENUE
City GAITHERSBURG
State MD
ZIP 20877
Phone 240 631-7716
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 SHARAREH KHANJANI

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