02D0979869 CLIA NUMBER - FRED MEYER PHARMACY #653

Laboratory Demographics

  • CLIA Code: 02D0979869
  • Facility Name: FRED MEYER PHARMACY #653
  • Facility Address: 1501 EAST PARKS DRIVE
    WASILLA, AK
    ZIP 99654
  • Facility Phone: 907 352-5033
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA HENSLEY
  • NPI Number: 1295770725
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 02D0979869
LAB Type Pharmacy
Facility Name FRED MEYER PHARMACY #653
Street 1501 EAST PARKS DRIVE
City WASILLA
State AK
ZIP 99654
Phone 907 352-5033
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/9/2025
Certificate Expiration Date 3/8/2027
Facility Type Pharmacy
Lab Director KAYLA HENSLEY

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