45D2141913 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4948

Laboratory Demographics

  • CLIA Code: 45D2141913
  • Facility Name: SAM'S CLUB PHARMACY 10-4948
  • Facility Address: 5749 SHERWOOD WAY
    SAN ANGELO, TX
    ZIP 76901
  • Facility Phone: 325 223-9373
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID P. KRESTA
  • NPI Number: 1902998412
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2141913
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4948
Street 5749 SHERWOOD WAY
City SAN ANGELO
State TX
ZIP 76901
Phone 325 223-9373
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2023
Certificate Expiration Date 12/26/2025
Facility Type Pharmacy
Lab Director DAVID P. KRESTA

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