03D2095039 CLIA NUMBER - FRY'S PHARMACY #059

Laboratory Demographics

  • CLIA Code: 03D2095039
  • Facility Name: FRY'S PHARMACY #059
  • Facility Address: 4351 E HIGHWAY 90
    SIERRA VISTA, AZ
    ZIP 85635
  • Facility Phone: 520 458-0997
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUDITH HIPPERT
  • NPI Number: 1194153148
  • Taxonomy: 302R00000X - Health Maintenance Organization

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CLIA Record

Field Name Field Value
CLIA Number 03D2095039
LAB Type Pharmacy
Facility Name FRY'S PHARMACY #059
Street 4351 E HIGHWAY 90
City SIERRA VISTA
State AZ
ZIP 85635
Phone 520 458-0997
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2025
Certificate Expiration Date 4/27/2027
Facility Type Pharmacy
Lab Director JUDITH HIPPERT

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