46D2135190 CLIA NUMBER - LEE'S MARKET PLACE LOGAN PHARMACY

Laboratory Demographics

  • CLIA Code: 46D2135190
  • Facility Name: LEE'S MARKET PLACE LOGAN PHARMACY
  • Facility Address: 555 EAST 1400 NORTH
    LOGAN, UT
    ZIP 84341
  • Facility Phone: 435 750-0258
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACOB NELSON
  • NPI Number: 1487702668
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2135190
LAB Type Pharmacy
Facility Name LEE'S MARKET PLACE LOGAN PHARMACY
Street 555 EAST 1400 NORTH
City LOGAN
State UT
ZIP 84341
Phone 435 750-0258
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Pharmacy
Lab Director JACOB NELSON

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