46D2042888 CLIA NUMBER - PETERSON MARKET, LLC

Laboratory Demographics

  • CLIA Code: 46D2042888
  • Facility Name: PETERSON MARKET, LLC
  • Facility Address: 1784 W 12600 S
    RIVERTON, UT
    ZIP 84065
  • Facility Phone: 801 254-0809
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DARRYL WAGNER
  • NPI Number: 1598776148
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2042888
LAB Type Pharmacy
Facility Name PETERSON MARKET, LLC
Street 1784 W 12600 S
City RIVERTON
State UT
ZIP 84065
Phone 801 254-0809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/21/2024
Certificate Expiration Date 6/20/2026
Facility Type Pharmacy
Lab Director DARRYL WAGNER

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