23D2099780 CLIA NUMBER - SAM'S PHARMACY 10-6661

Laboratory Demographics

  • CLIA Code: 23D2099780
  • Facility Name: SAM'S PHARMACY 10-6661
  • Facility Address: 7021 S WESTNEDGE AVENUE
    PORTAGE, MI
    ZIP 49002
  • Facility Phone: 269 327-2579
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN D. BECKNER
  • NPI Number: 1659398147
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2099780
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6661
Street 7021 S WESTNEDGE AVENUE
City PORTAGE
State MI
ZIP 49002
Phone 269 327-2579
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 STEPHEN D. BECKNER

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