13D0662790 CLIA NUMBER - ST LUKES CLINIC FAMILY HEALTH WEST BOISE

Laboratory Demographics

CLIA Number: 13D0662790

Facility Name: ST LUKES CLINIC FAMILY HEALTH WEST BOISE

Facility Address:
12080 W MCMILLAN RD
BOISE, ID
ZIP 83713
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Facility Phone Number: 208 375-4955

Facility Type: Community Clinic

Certificate Type: Microscopy

NPI Number: 1386302131

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	13D0662790
LAB Type	Community Clinic
Facility Name	ST LUKES CLINIC FAMILY HEALTH WEST BOISE
Street	12080 W MCMILLAN RD
City	BOISE
State	ID
ZIP	83713
Phone	208 375-4955
CertificateType	3
CertificateEffectiveDate	3/20/2024
CertificateExpirationDate	3/19/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024