45D2123122 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8224

Laboratory Demographics

  • CLIA Code: 45D2123122
  • Facility Name: SAM'S CLUB PHARMACY 10-8224
  • Facility Address: 3801 KELL BLVD
    WICHITA FALLS, TX
    ZIP 76308
  • Facility Phone: 940 691-7296
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFF L. BRISTO
  • NPI Number: 1528144714
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2123122
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8224
Street 3801 KELL BLVD
City WICHITA FALLS
State TX
ZIP 76308
Phone 940 691-7296
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 JEFF L. BRISTO

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