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46D1031890 CLIA NUMBER - MACEY'S PHARMACY #1058

Laboratory Demographics

CLIA Number: 46D1031890

Facility Name: MACEY'S PHARMACY #1058

Facility Address:
4530 S HIGHLAND DRIVE
SALT LAKE CITY, UT
ZIP 84111
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Facility Phone Number: 801 278-5388

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1326371584

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 46D1031890
LAB Type Pharmacy
Facility Name MACEY'S PHARMACY #1058
Street 4530 S HIGHLAND DRIVE
City SALT LAKE CITY
State UT
ZIP 84111
Phone 801 278-5388
CertificateType 4
CertificateEffectiveDate 12/21/2022
CertificateExpirationDate 12/20/2024
FacilityType Waiver

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