21D2146505 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6239

Laboratory Demographics

  • CLIA Code: 21D2146505
  • Facility Name: SAM'S CLUB PHARMACY 10-6239
  • Facility Address: 15 TEXAS STATION COURT
    TIMONIUM, MD
    ZIP 21093
  • Facility Phone: 410 628-7264
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TED A. WADDELL
  • NPI Number: 1902904030
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 21D2146505
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6239
Street 15 TEXAS STATION COURT
City TIMONIUM
State MD
ZIP 21093
Phone 410 628-7264
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 TED A. WADDELL

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