36D2142001 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8139

Laboratory Demographics

  • CLIA Code: 36D2142001
  • Facility Name: SAM'S CLUB PHARMACY 10-8139
  • Facility Address: 1300 E MALL DRIVE
    HOLLAND, OH
    ZIP 43528
  • Facility Phone: 419 868-1398
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON M. GABLE RPH
  • NPI Number: 1508960931
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 36D2142001
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8139
Street 1300 E MALL DRIVE
City HOLLAND
State OH
ZIP 43528
Phone 419 868-1398
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/29/2023
Certificate Expiration Date 12/28/2025
Facility Type Pharmacy
Lab Director JASON M. GABLE RPH

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