46D2206053 CLIA NUMBER - WALGREENS #15290

Laboratory Demographics

  • CLIA Code: 46D2206053
  • Facility Name: WALGREENS #15290
  • Facility Address: 1208 WASHINGTON BLVD
    OGDEN, UT
    ZIP 84404
  • Facility Phone: 801 621-1367
  • Facility Type: Other - COVID-19 TESTING SITE
  • Facility Type: Waiver
  • Lab Director: BO TUCKER SHUPE
  • NPI Number: 1750712196
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2206053
LAB Type Other - COVID-19 TESTING SITE
Facility Name WALGREENS #15290
Street 1208 WASHINGTON BLVD
City OGDEN
State UT
ZIP 84404
Phone 801 621-1367
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Other - COVID-19 TESTING SITE
Lab Director BO TUCKER SHUPE

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