46D2060370 CLIA NUMBER - WALGREENS #05929

Laboratory Demographics

  • CLIA Code: 46D2060370
  • Facility Name: WALGREENS #05929
  • Facility Address: 5630 W 4100 S
    WEST VALLEY, UT
    ZIP 84128
  • Facility Phone: 801 840-5155
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VENKATA R. GUDIPATI
  • NPI Number: 1811902844
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2060370
LAB Type Pharmacy
Facility Name WALGREENS #05929
Street 5630 W 4100 S
City WEST VALLEY
State UT
ZIP 84128
Phone 801 840-5155
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director VENKATA R. GUDIPATI

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