24D2099484 CLIA NUMBER - SAM'S PHARMACY 10-6510

Laboratory Demographics

  • CLIA Code: 24D2099484
  • Facility Name: SAM'S PHARMACY 10-6510
  • Facility Address: 1831 EAST MADISON AVE
    MANKATO, MN
    ZIP 56001
  • Facility Phone: 507 387-4205
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRISHA JOHNSON
  • NPI Number: 1417299793
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2099484
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6510
Street 1831 EAST MADISON AVE
City MANKATO
State MN
ZIP 56001
Phone 507 387-4205
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director TRISHA JOHNSON

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