45D2123119 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8242

Laboratory Demographics

  • CLIA Code: 45D2123119
  • Facility Name: SAM'S CLUB PHARMACY 10-8242
  • Facility Address: 12000 MCCREE ROAD
    DALLAS, TX
    ZIP 75238
  • Facility Phone: 214 461-8777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THAO N. KHAMNOUANE
  • NPI Number: 1932281136
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2123119
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8242
Street 12000 MCCREE ROAD
City DALLAS
State TX
ZIP 75238
Phone 214 461-8777
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 THAO N. KHAMNOUANE

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