45D2123195 CLIA NUMBER - SAM'S CLUB PHARMACY 10-8210

Laboratory Demographics

  • CLIA Code: 45D2123195
  • Facility Name: SAM'S CLUB PHARMACY 10-8210
  • Facility Address: 600 N BURLESON BLVD
    BURLESON, TX
    ZIP 76028
  • Facility Phone: 817 568-9652
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHLYNN T. PHAM
  • NPI Number: 1700962990
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2123195
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-8210
Street 600 N BURLESON BLVD
City BURLESON
State TX
ZIP 76028
Phone 817 568-9652
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/14/2024
Certificate Expiration Date 12/13/2026
Facility Type Pharmacy
Lab Director KATHLYNN T. PHAM

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