24D2099827 CLIA NUMBER - SAM'S PHARMACY 10-4787

Laboratory Demographics

  • CLIA Code: 24D2099827
  • Facility Name: SAM'S PHARMACY 10-4787
  • Facility Address: 200 AMERICAN BLVD WEST
    BLOOMINGTON, MN
    ZIP 55420
  • Facility Phone: 952 888-6079
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA TIMMERMAN
  • NPI Number: 1356368757
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2099827
LAB Type Pharmacy
Facility Name SAM'S PHARMACY 10-4787
Street 200 AMERICAN BLVD WEST
City BLOOMINGTON
State MN
ZIP 55420
Phone 952 888-6079
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 AMANDA TIMMERMAN

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