36D2133285 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6302

Laboratory Demographics

  • CLIA Code: 36D2133285
  • Facility Name: SAM'S CLUB PHARMACY 10-6302
  • Facility Address: 23300 BROADWAY AVE
    OAKWOOD VILLAGE, OH
    ZIP 44146
  • Facility Phone: 440 201-1187
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC T. MACGILLIS
  • NPI Number: 1639557838
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2133285
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6302
Street 23300 BROADWAY AVE
City OAKWOOD VILLAGE
State OH
ZIP 44146
Phone 440 201-1187
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Pharmacy
Lab Director ERIC T. MACGILLIS

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