21D2150706 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6357

Laboratory Demographics

  • CLIA Code: 21D2150706
  • Facility Name: SAM'S CLUB PHARMACY 10-6357
  • Facility Address: 2100 GENERALS HIGHWAY
    ANNAPOLIS, MD
    ZIP 21401
  • Facility Phone: 410 224-7669
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TREVOR C. WHITESIDE
  • NPI Number: 1225129760
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 21D2150706
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6357
Street 2100 GENERALS HIGHWAY
City ANNAPOLIS
State MD
ZIP 21401
Phone 410 224-7669
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Pharmacy
Lab Director TREVOR C. WHITESIDE

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