46D2138962 CLIA NUMBER - WALMART PHARMACY 10-2307

Laboratory Demographics

  • CLIA Code: 46D2138962
  • Facility Name: WALMART PHARMACY 10-2307
  • Facility Address: 11328 S JORDAN GATEWAY RD
    SOUTH JORDAN, UT
    ZIP 84095
  • Facility Phone: 801 553-2270
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHEN SIMISTER
  • NPI Number: 1932570348
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 46D2138962
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2307
Street 11328 S JORDAN GATEWAY RD
City SOUTH JORDAN
State UT
ZIP 84095
Phone 801 553-2270
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 STEPHEN SIMISTER

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