24D2100927 CLIA NUMBER - SAM'S PHARMACY 10-6320

Laboratory Demographics

CLIA Number: 24D2100927

Facility Name: SAM'S PHARMACY 10-6320

Facility Address:
4743 MAPLE GROVE ROAD
HERMANTOWN, MN
ZIP 55811
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Facility Phone Number: 218 279-2858

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1700803194

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	24D2100927
LAB Type	Pharmacy
Facility Name	SAM'S PHARMACY 10-6320
Street	4743 MAPLE GROVE ROAD
City	HERMANTOWN
State	MN
ZIP	55811
Phone	218 279-2858
CertificateType	4
CertificateEffectiveDate	8/25/2023
CertificateExpirationDate	8/24/2025
FacilityType	Waiver

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