37D2126574 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6779 SAM'S WEST, INC

Laboratory Demographics

  • CLIA Code: 37D2126574
  • Facility Name: SAM'S CLUB PHARMACY 10-6779 SAM'S WEST, INC
  • Facility Address: 1705 SOUTH BROADWAY AVE
    MOORE, OK
    ZIP 73160
  • Facility Phone: 405 300-6027
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAUREN T. BOSWELL
  • NPI Number: 1235520057
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 37D2126574
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6779 SAM'S WEST, INC
Street 1705 SOUTH BROADWAY AVE
City MOORE
State OK
ZIP 73160
Phone 405 300-6027
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Pharmacy
Lab Director LAUREN T. BOSWELL

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