46D1035968 CLIA NUMBER - MACEY'S PHARMACY #3

Laboratory Demographics

  • CLIA Code: 46D1035968
  • Facility Name: MACEY'S PHARMACY #3
  • Facility Address: 1402 N STATE STREET
    PROVO, UT
    ZIP 84601
  • Facility Phone: 801 377-0307
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL STAPLETON
  • NPI Number: 1083723217
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D1035968
LAB Type Pharmacy
Facility Name MACEY'S PHARMACY #3
Street 1402 N STATE STREET
City PROVO
State UT
ZIP 84601
Phone 801 377-0307
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/18/2025
Certificate Expiration Date 1/17/2027
Facility Type Pharmacy
Lab Director DANIEL STAPLETON

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