45D2128809 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4958

Laboratory Demographics

  • CLIA Code: 45D2128809
  • Facility Name: SAM'S CLUB PHARMACY 10-4958
  • Facility Address: 1350 LEAH AVE
    SAN MARCOS, TX
    ZIP 78666
  • Facility Phone: 512 392-1963
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EUISUNG KIM
  • NPI Number: 1689701088
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2128809
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4958
Street 1350 LEAH AVE
City SAN MARCOS
State TX
ZIP 78666
Phone 512 392-1963
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Pharmacy
Lab Director EUISUNG KIM

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