46D2141130 CLIA NUMBER - WALMART PHARMACY 10-4700

Laboratory Demographics

  • CLIA Code: 46D2141130
  • Facility Name: WALMART PHARMACY 10-4700
  • Facility Address: 1707 WEST STATE STREET
    PLEASANT GROVE, UT
    ZIP 84062
  • Facility Phone: 801 216-0003
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFREY MANNING
  • NPI Number: 1053723841
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2141130
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4700
Street 1707 WEST STATE STREET
City PLEASANT GROVE
State UT
ZIP 84062
Phone 801 216-0003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/7/2023
Certificate Expiration Date 12/6/2025
Facility Type Pharmacy
Lab Director JEFFREY MANNING

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