44D2137733 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4930

Laboratory Demographics

CLIA Number: 44D2137733

Facility Name: SAM'S CLUB PHARMACY 10-4930

Facility Address:
1177 SAMS STREET
COOKEVILLE, TN
ZIP 38506
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Facility Phone Number: 931 372-0300

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245624071

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	44D2137733
LAB Type	Pharmacy
Facility Name	SAM'S CLUB PHARMACY 10-4930
Street	1177 SAMS STREET
City	COOKEVILLE
State	TN
ZIP	38506
Phone	931 372-0300
CertificateType	4
CertificateEffectiveDate	10/3/2023
CertificateExpirationDate	10/2/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024