46D2133190 CLIA NUMBER - SAM'S CLUB PHARMACY 10-4786

Laboratory Demographics

  • CLIA Code: 46D2133190
  • Facility Name: SAM'S CLUB PHARMACY 10-4786
  • Facility Address: 145 W CACHE VALLEY BLVD
    LOGAN, UT
    ZIP 84341
  • Facility Phone: 435 787-0495
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL T. BRADLEY
  • NPI Number: 1205911146
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 46D2133190
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-4786
Street 145 W CACHE VALLEY BLVD
City LOGAN
State UT
ZIP 84341
Phone 435 787-0495
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 PAUL T. BRADLEY

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