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

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Laboratory Demographics

CLIA Number: 24D2099827

Facility Name: SAM'S PHARMACY 10-4787

Facility Address:
200 WEST AMERICAN BLVD
BLOOMINGTON, MN
ZIP 55420
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Facility Phone Number: 952 888-6079

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1356368757

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	24D2099827
LAB Type	Pharmacy
Facility Name	SAM'S PHARMACY 10-4787
Street	200 WEST AMERICAN BLVD
City	BLOOMINGTON
State	MN
ZIP	55420
Phone	952 888-6079
CertificateType	4
CertificateEffectiveDate	8/3/2023
CertificateExpirationDate	8/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024