24D2099668 CLIA NUMBER - SAM'S PHARMACY 10-6309

Laboratory Demographics

  • CLIA Code: 24D2099668
  • Facility Name: SAM'S PHARMACY 10-6309
  • Facility Address: 1850 BUERKLE ROAD
    WHITE BEAR LAKE, MN
    ZIP 55110
  • Facility Phone: 651 779-6710
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NUNMOULA MAZHARI
  • NPI Number: 1366469769
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2099668
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6309
Street 1850 BUERKLE ROAD
City WHITE BEAR LAKE
State MN
ZIP 55110
Phone 651 779-6710
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 NUNMOULA MAZHARI

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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