46D2138972 CLIA NUMBER - WALMART PHARMACY 10-4272

Laboratory Demographics

  • CLIA Code: 46D2138972
  • Facility Name: WALMART PHARMACY 10-4272
  • Facility Address: 1150 S 100 W
    LOGAN, UT
    ZIP 84321
  • Facility Phone: 435 787-4143
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FERRIS DERBIDGE
  • NPI Number: 1326281221
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2138972
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4272
Street 1150 S 100 W
City LOGAN
State UT
ZIP 84321
Phone 435 787-4143
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 FERRIS DERBIDGE

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