46D2133186 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4718

Laboratory Demographics

  • CLIA Code: 46D2133186
  • Facility Name: SAM'S CLUB PHARMACY 10-4718
  • Facility Address: 11278 S JORDAN GTWY
    SOUTH JORDAN, UT
    ZIP 84095
  • Facility Phone: 801 545-9815
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NIEL R. HARMON
  • NPI Number: 1184886913
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 46D2133186
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4718
Street 11278 S JORDAN GTWY
City SOUTH JORDAN
State UT
ZIP 84095
Phone 801 545-9815
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Pharmacy
Lab Director NIEL R. HARMON

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