46D2138959 CLIA NUMBER - WALMART PHARMACY 10-1888

Laboratory Demographics

  • CLIA Code: 46D2138959
  • Facility Name: WALMART PHARMACY 10-1888
  • Facility Address: 1550N MAIN ST
    N LOGAN, UT
    ZIP 84341
  • Facility Phone: 435 753-0990
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENT H. PETERSEN
  • NPI Number: 1619053808
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 46D2138959
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1888
Street 1550N MAIN ST
City N LOGAN
State UT
ZIP 84341
Phone 435 753-0990
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2023
Certificate Expiration Date 10/26/2025
Facility Type Pharmacy
Lab Director KENT H. PETERSEN

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