36D2141105 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6326

Laboratory Demographics

  • CLIA Code: 36D2141105
  • Facility Name: SAM'S CLUB PHARMACY 10-6326
  • Facility Address: 2675 TAYLOR ROAD EXT
    REYNOLDSBURG, OH
    ZIP 43068
  • Facility Phone: 614 866-7742
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IDELLA MASONGSONG
  • NPI Number: 1053414680
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 36D2141105
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6326
Street 2675 TAYLOR ROAD EXT
City REYNOLDSBURG
State OH
ZIP 43068
Phone 614 866-7742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2023
Certificate Expiration Date 12/6/2025
Facility Type Pharmacy
Lab Director IDELLA MASONGSONG

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