21D2146504 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6655

Laboratory Demographics

  • CLIA Code: 21D2146504
  • Facility Name: SAM'S CLUB PHARMACY 10-6655
  • Facility Address: 2365 CRAIN HIGHWAY
    WALDORF, MD
    ZIP 20601
  • Facility Phone: 301 932-8260
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER J. WATKINS
  • NPI Number: 1962593343
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 21D2146504
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6655
Street 2365 CRAIN HIGHWAY
City WALDORF
State MD
ZIP 20601
Phone 301 932-8260
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2024
Certificate Expiration Date 3/29/2026
Facility Type Pharmacy
Lab Director TYLER J. WATKINS

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