52D2258429 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4840

Laboratory Demographics

  • CLIA Code: 52D2258429
  • Facility Name: SAM'S CLUB PHARMACY 10-4840
  • Facility Address: 3900 DEERFILED DR
    JANESVILLE, WI
    ZIP 53546
  • Facility Phone: 414 410-2551
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE NORDVALL
  • NPI Number: 1841381415
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 52D2258429
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4840
Street 3900 DEERFILED DR
City JANESVILLE
State WI
ZIP 53546
Phone 414 410-2551
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2024
Certificate Expiration Date 4/20/2026
Facility Type Pharmacy
Lab Director JACQUELINE NORDVALL

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