49D2131658 CLIA NUMBER - SAM'S EAST, LP D/B/A SAM'S PHARMACY #10-6351

Laboratory Demographics

CLIA Number: 49D2131658

Facility Name: SAM'S EAST, LP D/B/A SAM'S PHARMACY #10-6351

Facility Address:
12407 JEFFERSON AVENUE
NEWPORT NEWS, VA
ZIP 23602
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Facility Phone Number: 757 874-2096

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1902823016

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	49D2131658
LAB Type	Pharmacy
Facility Name	SAM'S EAST, LP D/B/A SAM'S PHARMACY #10-6351
Street	12407 JEFFERSON AVENUE
City	NEWPORT NEWS
State	VA
ZIP	23602
Phone	757 874-2096
CertificateType	4
CertificateEffectiveDate	6/5/2023
CertificateExpirationDate	6/4/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024