24D2099658 CLIA NUMBER - SAM'S PHARMACY 10-6312

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Laboratory Demographics

CLIA Number: 24D2099658

Facility Name: SAM'S PHARMACY 10-6312

Facility Address:
9925 HUDSON ROAD
WOODBURY, MN
ZIP 55125
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Facility Phone Number: 651 702-7980

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1710904115

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	24D2099658
LAB Type	Pharmacy
Facility Name	SAM'S PHARMACY 10-6312
Street	9925 HUDSON ROAD
City	WOODBURY
State	MN
ZIP	55125
Phone	651 702-7980
CertificateType	4
CertificateEffectiveDate	7/30/2023
CertificateExpirationDate	7/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024