24D2099663 CLIA NUMBER - SAM'S PHARMACY 10-6310

Laboratory Demographics

  • CLIA Code: 24D2099663
  • Facility Name: SAM'S PHARMACY 10-6310
  • Facility Address: 8150 UNIVERSITY AVE NE
    FRIDLEY, MN
    ZIP 55432
  • Facility Phone: 763 792-6653
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS MOREN
  • NPI Number: 1275550675
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2099663
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6310
Street 8150 UNIVERSITY AVE NE
City FRIDLEY
State MN
ZIP 55432
Phone 763 792-6653
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 THOMAS MOREN

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