52D2259408 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6535

Laboratory Demographics

  • CLIA Code: 52D2259408
  • Facility Name: SAM'S CLUB PHARMACY 10-6535
  • Facility Address: 226200 RIB MOUNTAIN DR
    WAUSAU, WI
    ZIP 54401
  • Facility Phone: 715 355-0161
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICOLE R. TIEMAN
  • NPI Number: 1215138557
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 52D2259408
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6535
Street 226200 RIB MOUNTAIN DR
City WAUSAU
State WI
ZIP 54401
Phone 715 355-0161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Pharmacy
Lab Director NICOLE R. TIEMAN

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