45D2097554 CLIA NUMBER - SAMS CLUB PHARMACY 10-6376

Laboratory Demographics

  • CLIA Code: 45D2097554
  • Facility Name: SAMS CLUB PHARMACY 10-6376
  • Facility Address: 4062 LBJ FREEWAY
    DALLAS, TX
    ZIP 75244
  • Facility Phone: 972 759-6492
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SO JEONG KIM
  • NPI Number: 1700270014
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2097554
LAB Type Pharmacy
Facility Name SAMS CLUB PHARMACY 10-6376
Street 4062 LBJ FREEWAY
City DALLAS
State TX
ZIP 75244
Phone 972 759-6492
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/18/2025
Certificate Expiration Date 6/17/2027
Facility Type Pharmacy
Lab Director SO JEONG KIM

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