45D2126172 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6422

Laboratory Demographics

  • CLIA Code: 45D2126172
  • Facility Name: SAM'S CLUB PHARMACY 10-6422
  • Facility Address: 3310 N 4TH STREET
    LONGVIEW, TX
    ZIP 75605
  • Facility Phone: 903 838-4338
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALLYSON MARTIN
  • NPI Number: 1063791721
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2126172
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6422
Street 3310 N 4TH STREET
City LONGVIEW
State TX
ZIP 75605
Phone 903 838-4338
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2025
Certificate Expiration Date 2/20/2027
Facility Type Pharmacy
Lab Director ALLYSON MARTIN

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