46D2298117 CLIA NUMBER - EDGEMONT PHARMACY

Laboratory Demographics

  • CLIA Code: 46D2298117
  • Facility Name: EDGEMONT PHARMACY
  • Facility Address: 3661 N CANYON RD
    PROVO, UT
    ZIP 84604
  • Facility Phone: 801 226-7994
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIKE CHAMBERLAIN
  • NPI Number: 1659301885
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 46D2298117
LAB Type Pharmacy
Facility Name EDGEMONT PHARMACY
Street 3661 N CANYON RD
City PROVO
State UT
ZIP 84604
Phone 801 226-7994
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/29/2024
Certificate Expiration Date 1/28/2026
Facility Type Pharmacy
Lab Director MIKE CHAMBERLAIN

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