32D2139069 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4961

Laboratory Demographics

  • CLIA Code: 32D2139069
  • Facility Name: SAM'S CLUB PHARMACY 10-4961
  • Facility Address: 4400 N MAIN ST
    ROSWELL, NM
    ZIP 88201
  • Facility Phone: 575 627-9866
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REFUGIO R. SOLIS
  • NPI Number: 1902920093
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 32D2139069
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4961
Street 4400 N MAIN ST
City ROSWELL
State NM
ZIP 88201
Phone 575 627-9866
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/30/2023
Certificate Expiration Date 10/29/2025
Facility Type Pharmacy
Lab Director REFUGIO R. SOLIS

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