46D2138982 CLIA NUMBER - WALMART PHARMACY 10-5763

Laboratory Demographics

  • CLIA Code: 46D2138982
  • Facility Name: WALMART PHARMACY 10-5763
  • Facility Address: 3590 W SOUTH JORDAN PKWY
    S JORDAN, UT
    ZIP 84095
  • Facility Phone: 801 601-3119
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRENT K. HIRAMOTO
  • NPI Number: 1689912594
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2138982
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5763
Street 3590 W SOUTH JORDAN PKWY
City S JORDAN
State UT
ZIP 84095
Phone 801 601-3119
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 BRENT K. HIRAMOTO

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