45D2128789 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4720

Laboratory Demographics

  • CLIA Code: 45D2128789
  • Facility Name: SAM'S CLUB PHARMACY 10-4720
  • Facility Address: 4970 W HIGHWAY 290
    AUSTIN, TX
    ZIP 78735
  • Facility Phone: 512 358-8695
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA CHUANG
  • NPI Number: 1740377415
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2128789
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4720
Street 4970 W HIGHWAY 290
City AUSTIN
State TX
ZIP 78735
Phone 512 358-8695
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director MELISSA CHUANG

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