45D2126270 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6262

Laboratory Demographics

  • CLIA Code: 45D2126270
  • Facility Name: SAM'S CLUB PHARMACY 10-6262
  • Facility Address: 5565 DEZAVALA ROAD
    SAN ANTONIO, TX
    ZIP 78249
  • Facility Phone: 210 641-4810
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CLAUDIA MACIAS-CANTU
  • NPI Number: 1205926201
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2126270
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6262
Street 5565 DEZAVALA ROAD
City SAN ANTONIO
State TX
ZIP 78249
Phone 210 641-4810
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/22/2025
Certificate Expiration Date 2/21/2027
Facility Type Pharmacy
Lab Director CLAUDIA MACIAS-CANTU

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