23D2099784 CLIA NUMBER - SAM'S PHARMACY #6658

Laboratory Demographics

  • CLIA Code: 23D2099784
  • Facility Name: SAM'S PHARMACY #6658
  • Facility Address: 3600 O'NEILL DRIVE
    JACKSON, MI
    ZIP 49202
  • Facility Phone: 517 788-5961
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOHAMAD C. FALZALA
  • NPI Number: 1710904933
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2099784
LAB Type Pharmacy
Facility Name SAM'S PHARMACY #6658
Street 3600 O'NEILL DRIVE
City JACKSON
State MI
ZIP 49202
Phone 517 788-5961
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 MOHAMAD C. FALZALA

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