45D2142426 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6259

Laboratory Demographics

  • CLIA Code: 45D2142426
  • Facility Name: SAM'S CLUB PHARMACY 10-6259
  • Facility Address: 130 SUNDANCE PKWY STE 300
    ROUND ROCK, TX
    ZIP 78681
  • Facility Phone: 512 828-0557
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARYAM MANESH
  • NPI Number: 1396835393
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 45D2142426
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6259
Street 130 SUNDANCE PKWY STE 300
City ROUND ROCK
State TX
ZIP 78681
Phone 512 828-0557
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/10/2024
Certificate Expiration Date 1/9/2026
Facility Type Pharmacy
Lab Director MARYAM MANESH

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