23D2099769 CLIA NUMBER - SAM'S PHARMACY 10-6419

Laboratory Demographics

  • CLIA Code: 23D2099769
  • Facility Name: SAM'S PHARMACY 10-6419
  • Facility Address: 2401 N US HIGHWAY 31 S
    TRAVERSE CITY, MI
    ZIP 49684
  • Facility Phone: 231 995-0207
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DE LYNN K. SHEDLOCK
  • NPI Number: 1902823123
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2099769
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6419
Street 2401 N US HIGHWAY 31 S
City TRAVERSE CITY
State MI
ZIP 49684
Phone 231 995-0207
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Pharmacy
Lab Director DE LYNN K. SHEDLOCK

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