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

Laboratory Demographics

  • CLIA Code: 24D2100927
  • Facility Name: SAM'S PHARMACY 10-6320
  • Facility Address: 4743 MAPLE GROVE ROAD
    HERMANTOWN, MN
    ZIP 55811
  • Facility Phone: 218 279-2858
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIKE C. PERELL
  • NPI Number: 1700803194
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/25/2025
Certificate Expiration Date 8/24/2027
Facility Type Pharmacy
Lab Director MIKE C. PERELL

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