46D2138967 CLIA NUMBER - WALMART PHARMACY 10-4100

Laboratory Demographics

  • CLIA Code: 46D2138967
  • Facility Name: WALMART PHARMACY 10-4100
  • Facility Address: 2255 N UNIVERSITY PARKWAY
    PROVO, UT
    ZIP 84604
  • Facility Phone: 385 219-3077
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA L. KERR
  • NPI Number: 1447674569
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2138967
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4100
Street 2255 N UNIVERSITY PARKWAY
City PROVO
State UT
ZIP 84604
Phone 385 219-3077
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 CYNTHIA L. KERR

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