28D2134643 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6181

Laboratory Demographics

  • CLIA Code: 28D2134643
  • Facility Name: SAM'S CLUB PHARMACY 10-6181
  • Facility Address: 9851 S 71ST PLAZA
    PAPILLION, NE
    ZIP 68133
  • Facility Phone: 402 686-2393
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. ANDREW F. FORMAN
  • NPI Number: 1861808016
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 28D2134643
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6181
Street 9851 S 71ST PLAZA
City PAPILLION
State NE
ZIP 68133
Phone 402 686-2393
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2025
Certificate Expiration Date 8/6/2027
Facility Type Pharmacy
Lab Director MR. ANDREW F. FORMAN

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