24D2099660 CLIA NUMBER - SAM'S PHARMACY 10-6311

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Laboratory Demographics

CLIA Number: 24D2099660

Facility Name: SAM'S PHARMACY 10-6311

Facility Address:
8201 OLD CARRIAGE COURT
SHAKOPEE, MN
ZIP 55379
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Facility Phone Number: 952 496-2982

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1629095021

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	24D2099660
LAB Type	Pharmacy
Facility Name	SAM'S PHARMACY 10-6311
Street	8201 OLD CARRIAGE COURT
City	SHAKOPEE
State	MN
ZIP	55379
Phone	952 496-2982
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