45D2127656 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4713

Laboratory Demographics

  • CLIA Code: 45D2127656
  • Facility Name: SAM'S CLUB PHARMACY 10-4713
  • Facility Address: 19091 INTERSTATE 45 S
    SHENANDOAH, TX
    ZIP 77385
  • Facility Phone: 936 271-1732
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN C. KULIK
  • NPI Number: 1346335106
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2127656
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4713
Street 19091 INTERSTATE 45 S
City SHENANDOAH
State TX
ZIP 77385
Phone 936 271-1732
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/16/2025
Certificate Expiration Date 3/15/2027
Facility Type Pharmacy
Lab Director KEVIN C. KULIK

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