46D2011528 CLIA NUMBER - WALGREENS #11734

Laboratory Demographics

  • CLIA Code: 46D2011528
  • Facility Name: WALGREENS #11734
  • Facility Address: 1315 NORTH STATE ST
    PROVO, UT
    ZIP 84604
  • Facility Phone: 801 616-5223
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LACEY S. BRINGHURST
  • NPI Number: 1689849606
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2011528
LAB Type Pharmacy
Facility Name WALGREENS #11734
Street 1315 NORTH STATE ST
City PROVO
State UT
ZIP 84604
Phone 801 616-5223
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director LACEY S. BRINGHURST

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