45D2122954 CLIA NUMBER - SAMS CLUB PHARMACY 10-8284

Laboratory Demographics

  • CLIA Code: 45D2122954
  • Facility Name: SAMS CLUB PHARMACY 10-8284
  • Facility Address: 2025 S SOUTHWEST LOOP 323
    TYLER, TX
    ZIP 75701
  • Facility Phone: 903 597-1863
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEATHER DAVIS
  • NPI Number: 1174610752
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2122954
LAB Type Pharmacy
Facility Name SAMS CLUB PHARMACY 10-8284
Street 2025 S SOUTHWEST LOOP 323
City TYLER
State TX
ZIP 75701
Phone 903 597-1863
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2024
Certificate Expiration Date 12/8/2026
Facility Type Pharmacy
Lab Director HEATHER DAVIS

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