46D2133244 CLIA NUMBER - SAM'S CLUB PHARMACY 10-6685

Laboratory Demographics

  • CLIA Code: 46D2133244
  • Facility Name: SAM'S CLUB PHARMACY 10-6685
  • Facility Address: 1313 S UNIVERSITY AVE
    PROVO, UT
    ZIP 84601
  • Facility Phone: 801 373-5665
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOUIS T. WOLFGRAM
  • NPI Number: 1790879716
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 46D2133244
LAB Type Pharmacy
Facility Name SAM'S CLUB PHARMACY 10-6685
Street 1313 S UNIVERSITY AVE
City PROVO
State UT
ZIP 84601
Phone 801 373-5665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2025
Certificate Expiration Date 7/9/2027
Facility Type Pharmacy
Lab Director LOUIS T. WOLFGRAM

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