24D2099825 CLIA NUMBER - SAM'S PHARMACY 10-6254

Laboratory Demographics

  • CLIA Code: 24D2099825
  • Facility Name: SAM'S PHARMACY 10-6254
  • Facility Address: 16701 94TH AVE NORTH
    MAPLE GROVE, MN
    ZIP 55311
  • Facility Phone: 763 416-5930
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAYME GRONNEBERG
  • NPI Number: 1184641581
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2099825
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-6254
Street 16701 94TH AVE NORTH
City MAPLE GROVE
State MN
ZIP 55311
Phone 763 416-5930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/3/2025
Certificate Expiration Date 8/2/2027
Facility Type Pharmacy
Lab Director JAYME GRONNEBERG

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