51D2125983 CLIA NUMBER - SAM'S EAST INC DBA SAM'S PHARMACY #10-6373

Laboratory Demographics

  • CLIA Code: 51D2125983
  • Facility Name: SAM'S EAST INC DBA SAM'S PHARMACY #10-6373
  • Facility Address: 1100 GRAND CENTRAL AVE
    VIENNA, WV
    ZIP 26105
  • Facility Phone: 479 258-6734
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSIE MYERS
  • NPI Number: 1942575808
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 51D2125983
LAB Type Pharmacy
Facility Name SAM'S EAST INC DBA SAM'S PHARMACY #10-6373
Street 1100 GRAND CENTRAL AVE
City VIENNA
State WV
ZIP 26105
Phone 479 258-6734
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2025
Certificate Expiration Date 2/15/2027
Facility Type Pharmacy
Lab Director JESSIE MYERS

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