45D2123112 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8269

Laboratory Demographics

  • CLIA Code: 45D2123112
  • Facility Name: SAM'S CLUB PHARMACY 10-8269
  • Facility Address: 2325 W HIGHWAY I-20
    GRAND PRAIRIE, TX
    ZIP 75052
  • Facility Phone: 972 660-3405
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTIE A. JONES
  • NPI Number: 1669554010
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2123112
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8269
Street 2325 W HIGHWAY I-20
City GRAND PRAIRIE
State TX
ZIP 75052
Phone 972 660-3405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Pharmacy
Lab Director KRISTIE A. JONES

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