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

Laboratory Demographics

  • CLIA Code: 24D2099660
  • Facility Name: SAM'S PHARMACY 10-6311
  • Facility Address: 8201 OLD CARRIAGE COURT
    SHAKOPEE, MN
    ZIP 55379
  • Facility Phone: 952 496-2982
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM L. LETEXIER
  • NPI Number: 1629095021
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director WILLIAM L. LETEXIER

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